Provider Demographics
NPI:1598746349
Name:KUTSCHKE, KLAUS PETER (MD)
Entity Type:Individual
Prefix:
First Name:KLAUS
Middle Name:PETER
Last Name:KUTSCHKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:315 OAKGROVE ST
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-1176
Mailing Address - Country:US
Mailing Address - Phone:231-398-9266
Mailing Address - Fax:231-398-9268
Practice Address - Street 1:1293 E PARKDALE AVE
Practice Address - Street 2:STE 2300
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-8904
Practice Address - Country:US
Practice Address - Phone:231-398-1740
Practice Address - Fax:231-231-1749
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301051076208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5184760Medicaid
MI020515714OtherBCBS
MI020515714OtherBCBS
MIE16002102Medicare PIN