Provider Demographics
NPI:1619029824
Name:KUTTERUF AND ROBINSON MD PA
Entity Type:Organization
Organization Name:KUTTERUF AND ROBINSON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-667-5483
Mailing Address - Street 1:1607 LINCOLN WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2462
Mailing Address - Country:US
Mailing Address - Phone:203-667-5483
Mailing Address - Fax:208-667-7062
Practice Address - Street 1:1607 LINCOLN WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2462
Practice Address - Country:US
Practice Address - Phone:203-667-5483
Practice Address - Fax:208-667-7062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM3977207RC0000X
IDM3978207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002499500Medicaid
ID002499400Medicaid
ID002499500Medicaid
B63437Medicare UPIN
1113228Medicare PIN
1113246Medicare PIN