Provider Demographics
NPI:1194962365
Name:PHILLIP TUTNAUER DPM
Entity type:Organization
Organization Name:PHILLIP TUTNAUER DPM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:TUTNAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:928-725-9600
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:PINON
Mailing Address - State:AZ
Mailing Address - Zip Code:86510-0010
Mailing Address - Country:US
Mailing Address - Phone:928-725-9600
Mailing Address - Fax:
Practice Address - Street 1:2175 STATE RD 4
Practice Address - Street 2:
Practice Address - City:PINON
Practice Address - State:AZ
Practice Address - Zip Code:86510
Practice Address - Country:US
Practice Address - Phone:928-725-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01901213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3453201Medicaid
NJ3453201Medicaid
NJT89798Medicare UPIN