Healthcare Provider Details

I. General information

NPI: 1225089386
Provider Name (Legal Business Name): MARK LAWRENCE KUTLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N MACARTHUR BLVD
IRVING TX
75061
US

IV. Provider business mailing address

PO BOX 1888
GREENVILLE TX
75403
US

V. Phone/Fax

Practice location:
  • Phone: 972-579-8700
  • Fax:
Mailing address:
  • Phone: 800-945-2455
  • Fax: 903-453-2541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberF6850
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: