Provider Demographics
NPI:1629089164
Name:KUTTY, AHMED CK (MD)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:CK
Last Name:KUTTY
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 1:3015 AVENUE A
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-3525
Mailing Address - Country:US
Mailing Address - Phone:308-865-7271
Mailing Address - Fax:308-865-2045
Practice Address - Street 1:3015 AVE A
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-3525
Practice Address - Country:US
Practice Address - Phone:308-865-7271
Practice Address - Fax:308-865-2045
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18789207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47080450613Medicaid
KS774148OtherBCBS KS PROVIDER NUMBER
NE06190OtherBCBS NE PROVIDER NUMBER
KS057754Medicare ID - Type UnspecifiedMEDICARE KS PROVIDER NUMB
NE271605Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NE47080450613Medicaid