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General NPI Number Information
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NPI Number | 1376534578
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Entity Type | Individual
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Provider Name | JOEL KUTNICK MD
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Gender | Male
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Dates
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Enumeration Date | 11/04/2005
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Last Update Date | 02/10/2010
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Provider Practice Location Address
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Address Line | 316 INDEPENDENCE CREEK LN
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City | GEORGETOWN
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State | TX
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Zip | 78633-5314
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Country | US
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Telephone | 361-779-3009
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Fax | 512-869-5876
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Provider Business Mailing Address
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Address Line | 316 INDEPENDENCE CREEK LN
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City | GEORGETOWN
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State | TX
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Zip | 78633-5314
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Country | US
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Telephone | 361-779-3009
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Fax | 512-869-5876
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | E-0522
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License Number State | TX
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