Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | D.C. 002928-L | PA |
Y | 213ER0200X | Radiology | D.C. 002928-L | PA |
NPI | 1861585416 |
---|---|
Provider Name | Kurt M. Gutknecht |
First Address | Levittown, PA 19054-1227 |
Second Address | Levittown, PA 19054-1227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 11/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0023216000 | BLUE CROSS/SHIELD (01) | PA |
D.C.-002928-L | STATE LICENSE (01) | PA |