Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | OH-36-00-1819-K | OH |
NPI | 1154329225 |
---|---|
Provider Name | Dr. David A Kutlick |
First Address | East Liverpool, OH 43920-9657 |
Second Address | East Liverpool, OH 43920-9657 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 21/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0360961 | (05) | OH |
T80449 | (02) | OH |