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General NPI Number Information
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NPI Number | 1902921737
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Entity Type | Organization
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Legal Business Name | MICHAEL J KUTRYB MD PA
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 730 S WASHINGTON AVE
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City | TITUSVILLE
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State | FL
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Zip | 32780-4232
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Country | US
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Telephone | 321-267-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 730 S WASHINGTON AVE
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City | TITUSVILLE
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State | FL
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Zip | 32780-4232
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Country | US
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Telephone | 321-267-2020
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Fax | 321-267-4165
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MICHAEL J KUTRYB
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Credential | M.D.
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Telephone | 321-383-7888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME68787
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License Number State | FL
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