Provider Demographics
NPI:1215971189
Name:KUTSCHE, WILLIAM BLAKE (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BLAKE
Last Name:KUTSCHE
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 1:2323 TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:PECOS
Mailing Address - State:TX
Mailing Address - Zip Code:79772-7338
Mailing Address - Country:US
Mailing Address - Phone:432-447-3551
Mailing Address - Fax:432-447-5434
Practice Address - Street 1:2323 TEXAS ST
Practice Address - Street 2:
Practice Address - City:PECOS
Practice Address - State:TX
Practice Address - Zip Code:79772-7338
Practice Address - Country:US
Practice Address - Phone:432-447-3551
Practice Address - Fax:432-447-5434
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062066207V00000X, 207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4876421Medicaid
ECFMGOther03691540
MI4876600Medicaid
ECFMGOther03691540
MIN71040017Medicare PIN
MI4876421Medicaid