MEDICARE: CHARLOTTE L KUTSCH MD

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	207N00000X	Dermatology Physician	7807	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295815397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE L KUTSCH MD

Provider Business Mailing Address
First Line	:	2835 FORT MISSOULA RD
Second Line	:	STE 302
City	:	MISSOULA
State	:	MT
Zip	:	59804-7424
Country	:	US
Telephone Number	:	406-721-3497
Fax Number	:

Provider Business Practice Location Address
First Line	:	2835 FORT MISSOULA RD
Second Line	:	STE 302
City	:	MISSOULA
State	:	MT
Zip	:	59804-7424
Country	:	US
Telephone Number	:	406-721-3497
Fax Number	:

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	12/14/2016

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