Provider Demographics
NPI:1164497301
Name:KUTLU, HAKAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:HAKAN
Middle Name:M
Last Name:KUTLU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:95 MADISON AVE
Mailing Address - Street 2:SUITE 415
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6092
Mailing Address - Country:US
Mailing Address - Phone:973-644-3555
Mailing Address - Fax:973-644-3556
Practice Address - Street 1:95 MADISON AVE
Practice Address - Street 2:SUITE 415
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6092
Practice Address - Country:US
Practice Address - Phone:973-644-3555
Practice Address - Fax:973-644-3556
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ62792208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6815308Medicaid
NJ6815308Medicaid
NJ003960Medicare ID - Type Unspecified