Provider Demographics
NPI:1760443733
Name:CUTILLO, ROBERT P (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:P
Last Name:CUTILLO
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 1:3141 YORK ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-4166
Mailing Address - Country:US
Mailing Address - Phone:303-296-1767
Mailing Address - Fax:303-296-9313
Practice Address - Street 1:3800 YORK ST.
Practice Address - Street 2:INNER CITY HEALTH CENTER
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-3972
Practice Address - Country:US
Practice Address - Phone:303-296-1767
Practice Address - Fax:303-296-9313
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37787207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO65558774Medicaid
C46092Medicare UPIN
CO89934Medicare PIN
CO89934Medicare ID - Type Unspecified
CO65558774Medicaid