Healthcare Provider Details

I. General information

NPI: 1245206408
Provider Name (Legal Business Name): ROMAN L KUTSY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 112TH AVE NE STE D160
BELLEVUE WA
98004-3727
US

IV. Provider business mailing address

1750 112TH AVE NE STE D160
BELLEVUE WA
98004-3727
US

V. Phone/Fax

Practice location:
  • Phone: 425-637-2340
  • Fax: 425-637-0036
Mailing address:
  • Phone: 425-637-2340
  • Fax: 425-637-0036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD00032822
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberMD00032822
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: