MEDICARE: DR. KYLA S KUTCH DO

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	207P00000X	Emergency Medicine Physician	2002015294	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	32992014	OTHER	MO	BCBS MO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457352817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLA S KUTCH DO

Provider Business Mailing Address
First Line	:	2741 NE MCBAIN DR
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64064-7880
Country	:	US
Telephone Number	:	816-554-2600
Fax Number	:	816-554-2603

Provider Business Practice Location Address
First Line	:	2741 NE MCBAIN DR
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64064-7880
Country	:	US
Telephone Number	:	816-554-2600
Fax Number	:	816-554-2603

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	02/28/2013

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