Provider Demographics
NPI:1235211582
Name:KUTTERUF, GEORGE CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:CHRISTOPHER
Last Name:KUTTERUF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:G
Other - Middle Name:C
Other - Last Name:KUTTERUF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1607 LINCOLN WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2476
Mailing Address - Country:US
Mailing Address - Phone:208-667-5483
Mailing Address - Fax:208-667-7062
Practice Address - Street 1:1607 LINCOLN WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2476
Practice Address - Country:US
Practice Address - Phone:208-667-5483
Practice Address - Fax:208-667-5483
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM3978207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002499400Medicaid
1370105Medicare PIN
ID002499400Medicaid