Provider Demographics
NPI:1497742175
Name:KUTNIKAR, NARENDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:NARENDRA
Middle Name:
Last Name:KUTNIKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 LAMY LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3739
Mailing Address - Country:US
Mailing Address - Phone:318-388-5383
Mailing Address - Fax:318-388-5779
Practice Address - Street 1:1805 LAMY LN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3739
Practice Address - Country:US
Practice Address - Phone:318-388-5383
Practice Address - Fax:318-388-5779
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10610R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1992470Medicaid
F83787Medicare UPIN
LA5U453Medicare ID - Type Unspecified