Provider Demographics
NPI:1225051287
Name:KUTZ, STEPHEN M (MD, FACC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:KUTZ
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 WELLS ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2927
Mailing Address - Country:US
Mailing Address - Phone:401-596-4499
Mailing Address - Fax:401-596-6360
Practice Address - Street 1:45 WELLS ST
Practice Address - Street 2:SUITE 102
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2927
Practice Address - Country:US
Practice Address - Phone:401-596-4499
Practice Address - Fax:401-596-6360
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD-10264207RC0000X
CT040007207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007008112Medicaid
CT003115161Medicaid
CT003115161Medicaid
RI007008112Medicaid
G81538Medicare UPIN