Provider Demographics
NPI:1780763714
Name:CUTCHER, DOUGLAS ANTHONY (DPM)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ANTHONY
Last Name:CUTCHER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26029 5 MILE RD
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-3235
Mailing Address - Country:US
Mailing Address - Phone:313-255-7900
Mailing Address - Fax:
Practice Address - Street 1:26029 5 MILE RD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3235
Practice Address - Country:US
Practice Address - Phone:313-255-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI591001452213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5540710001OtherDMEC SUPPLIER ID
MI4216879Medicaid
MI4858256020OtherBLUE CROSS PROVIDER ID
MIB08003432OtherADMINSTAR FEDERAL ID
MI540H228370OtherBLUE CROSS DME
MI480008804OtherMEDICARE TRAVELERS ID
MIU03087Medicare UPIN
MIB08003432OtherADMINSTAR FEDERAL ID
MI4858256020OtherBLUE CROSS PROVIDER ID