MEDICARE: DR. MALIK A KUTTY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	N3126	TX
2	202K00000X	Phlebology Physician	N3126	TX

General Provider Information

NPI Number	:	1043227622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MALIK A KUTTY M.D.

Provider Business Mailing Address
First Line	:	3820 NORTHDALE BLVD STE 201
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-1893
Country	:	US
Telephone Number	:	800-991-6117
Fax Number	:	888-812-8191

Provider Business Practice Location Address
First Line	:	9303 PINECROFT DR STE 201
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-3181
Country	:	US
Telephone Number	:	800-991-6117
Fax Number	:	888-812-8191

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	09/12/2025

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