Provider Demographics
NPI:1417959289
Name:CHUTINAN, KUNNIKA (MD)
Entity Type:Individual
Prefix:DR
First Name:KUNNIKA
Middle Name:
Last Name:CHUTINAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N HIGHWAY 434 STE 4
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7041
Mailing Address - Country:US
Mailing Address - Phone:407-682-6612
Mailing Address - Fax:407-862-9616
Practice Address - Street 1:800 N HIGHWAY 434 STE 4
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-7041
Practice Address - Country:US
Practice Address - Phone:407-682-6612
Practice Address - Fax:407-862-9616
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME23494208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4218436OtherAETNA PPO
FL48737OtherBCBS
FL11687OtherHEALTHEASE MEDICAID
FL51369500Medicaid
FL288954OtherAETNA HMO
FL246612OtherSTAYWELL MEDICAID
FLD55421OtherUPIN