Provider Demographics
NPI:1376534578
Name:KUTNICK, JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:KUTNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:316 INDEPENDENCE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-5314
Mailing Address - Country:US
Mailing Address - Phone:361-779-3009
Mailing Address - Fax:512-869-5876
Practice Address - Street 1:316 INDEPENDENCE CREEK LN
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-5314
Practice Address - Country:US
Practice Address - Phone:361-779-3009
Practice Address - Fax:512-869-5876
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE-05222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G3805Medicare PIN
TXB24171Medicare UPIN