Provider Demographics
NPI:1235106428
Name:KUTINA, CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:KUTINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24651 CENTER RIDGE RD
Mailing Address - Street 2:STE 350
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5627
Mailing Address - Country:US
Mailing Address - Phone:440-895-5056
Mailing Address - Fax:440-333-2935
Practice Address - Street 1:25200 CENTER RIDGE RD
Practice Address - Street 2:SUITE 1200
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4141
Practice Address - Country:US
Practice Address - Phone:440-331-3047
Practice Address - Fax:440-331-3084
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35043393K207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1780634279OtherGROUP NPI
0119204OtherGROUP MEDICAID
10794581OtherCAQH
OH0416437Medicaid
9273172OtherGROUP MEDICARE
P00069300OtherRR MEDICARE INDIVIDUAL
3610861OtherGROUP ASC MEDICARE
120187OtherKAISER
CA4511OtherRR MEDICARE GROUP
D368301OtherGROUP IND DIAGNOSTICS MED
P00069300OtherRR MEDICARE INDIVIDUAL
34-1783789OtherGROUP TIN
P00069300OtherRR MEDICARE INDIVIDUAL
OH0471525Medicare PIN