Provider Demographics
NPI:1407375454
Name:MICHAEL KUTKA MD INC
Entity Type:Organization
Organization Name:MICHAEL KUTKA MD INC
Other - Org Name:MICHAEL KUTKA MD INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-521-7600
Mailing Address - Street 1:62 BROWN ST STE 206
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6790
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:62 BROWN ST STE 206
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6790
Practice Address - Country:US
Practice Address - Phone:978-521-7600
Practice Address - Fax:978-521-7600
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL KUTKA, MD, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110034689AMedicaid