Healthcare Provider Details

I. General information

NPI: 1619975216
Provider Name (Legal Business Name): LUKE CUTHERELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 KINGSLEY LN SUITE 400
NORFOLK VA
23505-4600
US

IV. Provider business mailing address

709 4TH AVE NE
WATFORD CITY ND
58854-7628
US

V. Phone/Fax

Practice location:
  • Phone: 757-889-6500
  • Fax:
Mailing address:
  • Phone: 701-444-8746
  • Fax: 701-842-4025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number19881
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: