Provider Demographics
NPI:1700032851
Name:KUTNIK, SHAWN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:MICHAEL
Last Name:KUTNIK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1000 DES PERES RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2050
Mailing Address - Country:US
Mailing Address - Phone:314-896-4263
Mailing Address - Fax:314-896-4263
Practice Address - Street 1:1000 DES PERES RD
Practice Address - Street 2:SUITE 210
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2050
Practice Address - Country:US
Practice Address - Phone:314-896-4263
Practice Address - Fax:314-896-4263
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2021-03-08
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Provider Licenses
StateLicense IDTaxonomies
MO2012013477207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery