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General NPI Number Information
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NPI Number | 1194806570
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Entity Type | Individual
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Provider Name | JEFFREY S KUTCHER MD
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Gender | Male
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 8273 GRAND RIVER RD 210
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City | BRIGHTON
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State | MI
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Zip | 48114-9346
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Country | US
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Telephone | 866-974-2673
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Fax | 866-939-2673
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Provider Business Mailing Address
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Address Line | 8273 GRAND RIVER RD STE 210
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City | BRIGHTON
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State | MI
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Zip | 48114-9346
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Country | US
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Telephone | 810-522-6080
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Fax | 810-522-6447
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084S0010X
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Taxonomy Name | Sports Medicine (Psychiatry & Neurology) Physician
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License Number | 4301073973
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 4301073973
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License Number State | MI
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