Provider Demographics
NPI:1952639189
Name:SUTKAMP, JERRY C (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:C
Last Name:SUTKAMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000 MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-1368
Mailing Address - Country:US
Mailing Address - Phone:859-441-9611
Mailing Address - Fax:859-441-9613
Practice Address - Street 1:2000 MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1368
Practice Address - Country:US
Practice Address - Phone:859-441-9611
Practice Address - Fax:859-441-9613
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY13698-KY207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine