Provider Demographics
NPI:1891883716
Name:KLAUS P. KUTSCHKE, M.D., P.C.
Entity Type:Organization
Organization Name:KLAUS P. KUTSCHKE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:KLAUS
Authorized Official - Middle Name:P
Authorized Official - Last Name:KUTSCHKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-723-7766
Mailing Address - Street 1:PO BOX 523
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49429-0523
Mailing Address - Country:US
Mailing Address - Phone:616-457-4919
Mailing Address - Fax:
Practice Address - Street 1:315 OAKGROVE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-1121
Practice Address - Country:US
Practice Address - Phone:231-723-7766
Practice Address - Fax:231-723-5540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051076208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3077322Medicaid
MIF87856Medicare UPIN
MI3077322Medicaid