Provider Demographics
NPI:1518040492
Name:TUTUS, MARA (MD)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:TUTUS
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 1:810 LUCERNE TER
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3731
Mailing Address - Country:US
Mailing Address - Phone:407-841-7730
Mailing Address - Fax:407-841-7660
Practice Address - Street 1:810 LUCERNE TER
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-3731
Practice Address - Country:US
Practice Address - Phone:407-841-7730
Practice Address - Fax:407-841-7660
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65116207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF72873Medicare UPIN
FL23718AMedicare ID - Type Unspecified