Provider Demographics
NPI:1710997994
Name:KUTIKOFF, KAREN R (MD, PA)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:R
Last Name:KUTIKOFF
Suffix:
Gender:F
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12957 PALMS WEST DRIVE,
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470
Mailing Address - Country:US
Mailing Address - Phone:561-790-3750
Mailing Address - Fax:561-792-5874
Practice Address - Street 1:12957 PALMS WEST DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470
Practice Address - Country:US
Practice Address - Phone:561-790-3750
Practice Address - Fax:561-792-5874
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63297207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18792OtherBC
FLF58207Medicare UPIN
FL18792AMedicare ID - Type Unspecified
F58207Medicare UPIN