Healthcare Provider Details

I. General information

NPI: 1396721569
Provider Name (Legal Business Name): MICHAEL CYRILL KUTSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 PRESTON RD.
PLANO TX
75024
US

IV. Provider business mailing address

2752 GASTON AVE APT 1232
DALLAS TX
75226-1352
US

V. Phone/Fax

Practice location:
  • Phone: 972-403-1300
  • Fax:
Mailing address:
  • Phone: 213-268-1894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberL9770
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: