Provider Demographics
NPI:1154329225
Name:KUTLICK, DAVID A (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:KUTLICK
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 1:15700 STATE ROUTE 170
Mailing Address - Street 2:SUITE B
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9657
Mailing Address - Country:US
Mailing Address - Phone:330-385-2227
Mailing Address - Fax:330-385-4242
Practice Address - Street 1:15700 STATE ROUTE 170
Practice Address - Street 2:SUITE B
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9657
Practice Address - Country:US
Practice Address - Phone:330-385-2227
Practice Address - Fax:330-385-4242
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2011-07-21
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
OHOH-36-00-1819-K213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0360961Medicaid
OHT80449Medicare UPIN
OH0360961Medicaid
OH4928010001Medicare NSC