Healthcare Provider Details

I. General information

NPI: 1114381100
Provider Name (Legal Business Name): MATTHEW PETER KUTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 06/18/2023
Certification Date: 06/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BROADWAY STE 270
SEATTLE WA
98122-5392
US

IV. Provider business mailing address

PO BOX 840842
DALLAS TX
75284-0862
US

V. Phone/Fax

Practice location:
  • Phone: 206-625-0578
  • Fax: 206-625-9184
Mailing address:
  • Phone: 206-625-0578
  • Fax: 206-625-9184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD61066475
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: