Provider Demographics
NPI:1821089087
Name:KUTINSKY, ILANA B (DO)
Entity Type:Individual
Prefix:
First Name:ILANA
Middle Name:B
Last Name:KUTINSKY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 INVESTMENT DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-6365
Mailing Address - Country:US
Mailing Address - Phone:248-267-5050
Mailing Address - Fax:248-267-5051
Practice Address - Street 1:4600 INVESTMENT DR
Practice Address - Street 2:SUITE 200
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-6365
Practice Address - Country:US
Practice Address - Phone:248-267-5050
Practice Address - Fax:248-267-5051
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35340207RC0001X
MI5101015554207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0656308955OtherBLUE CROSS BLUE SHIELD OF MI
MI060070669OtherMEDICARE RAILROAD
MI4475763Medicaid
MI0656308955OtherBLUE CROSS BLUE SHIELD OF MI
MI0F37214008Medicare PIN