Provider Demographics
NPI:1598840001
Name:JOSEPHKUTTY, SEBASTIAN - (MD; FCCP)
Entity Type:Individual
Prefix:DR
First Name:SEBASTIAN
Middle Name:-
Last Name:JOSEPHKUTTY
Suffix:
Gender:M
Credentials:MD; FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HEALTH PARK BLVD
Mailing Address - Street 2:SUITE # 326
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5771
Mailing Address - Country:US
Mailing Address - Phone:904-824-4532
Mailing Address - Fax:904-824-4024
Practice Address - Street 1:301 HEALTH PARK BLVD
Practice Address - Street 2:SUITE # 326
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5793
Practice Address - Country:US
Practice Address - Phone:904-824-4532
Practice Address - Fax:904-824-4024
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL167315207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255224800Medicaid
FLG81567Medicare UPIN
FL44412Medicare ID - Type Unspecified