Provider Demographics
NPI: | 1457416554 |
---|---|
Name: | KUTNER, MORRIS (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | MORRIS |
Middle Name: | |
Last Name: | KUTNER |
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: | 102 S EVERS ST |
Mailing Address - Street 2: | SUITE 104 |
Mailing Address - City: | PLANT CITY |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33563-5403 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 813-754-7756 |
Mailing Address - Fax: | 813-754-7565 |
Practice Address - Street 1: | 3058 HIGHLANDS BY THE LAKE WAY |
Practice Address - Street 2: | #6 |
Practice Address - City: | LAKELAND |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33812-5044 |
Practice Address - Country: | US |
Practice Address - Phone: | 863-687-1321 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-12-27 |
Last Update Date: | 2017-05-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | ME005867 | 207RG0300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RG0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 12375 | Other | BCBS |
FL | 0405441 | Other | EVERCARE |
FL | 054685200 | Medicaid | |
423475 | Other | AETNA | |
FL | 380001598 | Other | MEDICARE RAILROAD |
423475 | Other | AETNA | |
FL | 12375 | Other | BCBS |