Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MD430416 | PA |
NPI | 1033275433 |
---|---|
Provider Name | Alexander Kutikov |
First Address | Philadelphia, PA 19129-1302 |
Second Address | Philadelphia, PA 19111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 17/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10219876-0001 | (05) | PA |