MEDICARE: DR. KENNETH WILLIAM CUTLER 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	208000000X	Pediatrics Physician	G 70200	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G070200	OTHER	CA	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1285786889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH WILLIAM CUTLER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 10047
Second Line	:
City	:	TRUCKEE
State	:	CA
Zip	:	96162-0047
Country	:	US
Telephone Number	:	530-448-1798
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 CROWN POINT CIR
Second Line	:
City	:	GRASS VALLEY
State	:	CA
Zip	:	95945-9561
Country	:	US
Telephone Number	:	530-265-7154
Fax Number	:

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/30/2015

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