MEDICARE: DR. PETER MICHAEL MACHUTTA I L.A.C.

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	101Y00000X	Counselor	718	KS
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	718	KS

General Provider Information

NPI Number	:	1104253673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER MICHAEL MACHUTTA I L.A.C.

Provider Business Mailing Address
First Line	:	2020 E BLAKE ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67211-5353
Country	:	US
Telephone Number	:	316-641-7698
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 E BLAKE ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67211-5353
Country	:	US
Telephone Number	:	316-641-7698
Fax Number	:

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

Provider Enumeration Date	:	09/30/2013
Last Update Date	:	09/30/2013

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