Dr. Mark Raymond Kutyla
Radiology Sports Medicine Foot Surgery Primary Podiatric Medicine
121 Park Place Ct
Lexington
, South Carolina 29072-6690
Dr. Mark Raymond Kutyla
Radiology Sports Medicine Foot Surgery Primary Podiatric Medicine
121 Park Place Ct
Lexington
, South Carolina 29072-6690
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About
Features
Specialties
- Primary Podiatric Medicine
- Radiology
- Sports Medicine
- Foot Surgery
Languages spoken
- English
Location
First Address
- Dr. Mark Raymond Kutyla
- Po Box 6069
- West Columbia, SC
- Zip : 29171-6069
- Phone :
Second Address
- Dr. Mark Raymond Kutyla
- 121 Park Place Ct
- Lexington, SC
- Zip : 29072-6690
- Fax : (803) 356-0832
- Phone : (803) 356-4712
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 213EP1101X | Primary Podiatric Medicine | 516 | SC |
| N | 111NR0200X | Radiology | 516 | SC |
| N | 213ER0200X | Radiology | 516 | SC |
| N | 2081S0010X | Sports Medicine | 516 | SC |
| N | 213ES0000X | Sports Medicine | 516 | SC |
| Y | 213ES0131X | Foot Surgery | 516 | SC |
National Provider Identifier
| NPI | 1326007022 |
|---|---|
| Provider Name | Dr. Mark Raymond Kutyla |
| First Address | West Columbia, SC 29171-6069 |
| Second Address | Lexington, SC 29072-6690 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 21/03/2006 |
| Last Update Date | 09/11/2020 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 0433675 | CIGNA PROVIDER (01) | SC |
| 1015587 | ACM - NEWBERRY FOOT CLINIC (01) | SC |
| 1020003 | ACM - MIDLANDS FOOT CLINIC (01) | SC |
| 1326007022 | NPI # MARK R KUTYLA DPM (01) | SC |
| 1720032816 | NPI # FOR MIDLANDS FOOT CLINIC - PRIMARY PRACTICE LOCATION (01) | SC |
| 1851338461 | NPI # FOR NEWBERRY FOOT CLINIC - ADDITIONAL PRACTICE LOCATION (01) | SC |
| 42D2021725 | CLIA CERTIFICATE OF WAIVER FOR MIDLANDS FOOT CLINIC LOCATION (01) | SC |
| 42D2921723 | CLIA CERTIFICATE OF WAIVER FOR NEWBERRY FOOT CLINIC LOCATION (01) | SC |
| 480032059 | MEDICARE RAILROAD PROVIDER (01) | SC |
| 7238051 | AETNA PROVIDER (01) | SC |
| AA6969A | (02) | SC |
| K066682 | INTEGRATED HEALTH PLAN PROVIDER (01) | SC |
| U74396 | (02) | SC |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.