Provider Demographics
NPI:1972662229
Name:KAREN R KUTIKOFF MD PA
Entity Type:Organization
Organization Name:KAREN R KUTIKOFF MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KUTIKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-790-3750
Mailing Address - Street 1:12957 PALMS WEST DR
Mailing Address - Street 2:BLDG 9 SUITE 101
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4989
Mailing Address - Country:US
Mailing Address - Phone:561-790-3750
Mailing Address - Fax:561-792-5874
Practice Address - Street 1:12957 PALMS WEST DR
Practice Address - Street 2:BLDG 9 SUITE 101
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4989
Practice Address - Country:US
Practice Address - Phone:561-790-3750
Practice Address - Fax:561-792-5874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF58207Medicare UPIN
FL18792AMedicare ID - Type Unspecified