Provider Demographics
NPI:1770550212
Name:KUTINSKY, JULIAN (DO)
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:
Last Name:KUTINSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2405 E FOURTEEN MILE RD
Mailing Address - Street 2:MACOMB MEDICAL CLINIC PC
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310
Mailing Address - Country:US
Mailing Address - Phone:586-978-0850
Mailing Address - Fax:586-264-1155
Practice Address - Street 1:2405 E FOURTEEN MILE RD
Practice Address - Street 2:MACOMB MEDICAL CLINIC PC
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310
Practice Address - Country:US
Practice Address - Phone:586-978-0850
Practice Address - Fax:586-264-1155
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101005152207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2091757Medicaid
E26087Medicare UPIN
MIM32970008Medicare PIN
E26087Medicare UPIN