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
StateLicense IDTaxonomies
FLME005867207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12375OtherBCBS
FL0405441OtherEVERCARE
FL054685200Medicaid
423475OtherAETNA
FL380001598OtherMEDICARE RAILROAD
423475OtherAETNA
FL12375OtherBCBS