Healthcare Provider Details

I. General information

NPI: 1902854532
Provider Name (Legal Business Name): DAVID P KUTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 TUTTLE ST
BARABOO WI
53913-3319
US

IV. Provider business mailing address

1700 TUTTLE ST
BARABOO WI
53913-3319
US

V. Phone/Fax

Practice location:
  • Phone: 608-356-2145
  • Fax: 608-356-2147
Mailing address:
  • Phone: 608-356-2145
  • Fax: 608-356-2147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17589-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: