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DR. MARK RAYMOND KUTYLA DPM

Podiatric Medicine & Surgery Service Providers Podiatrist Primary Podiatric Medicine

Provider NPI: 1326007022

Provider Information:
DR. MARK RAYMOND KUTYLA DPM
Gender: M
Not Sole Proprietor

Practice Location:
121 PARK PLACE CT  LEXINGTON, SC 29072-6690 US
Tel: 803-356-4712  Fax: --

Business Mailing Address:
PO BOX 896239  CHARLOTTE, NC 28289-6239 US
Tel: 803-356-4712  Fax: --

NPI Information:
NPI: 1326007022
Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N213EP1101XPodiatric Medicine & Surgery Service Providers
Podiatrist
Primary Podiatric Medicine
SC516
N213ER0200XPodiatric Medicine & Surgery Service Providers
Podiatrist
SC516
N213ES0000XPodiatric Medicine & Surgery Service Providers
Podiatrist
SC516
Y213ES0131XPodiatric Medicine & Surgery Service Providers
Podiatrist
SC516
N2471M1202XTechnologists, Technicians & Other Technical Service Providers
Radiologic Technologist
SC516

Other Provider Identifiers:

IssuerNumberStateType
CLIA CERTIFICATE OF WAIVER FOR NEWBERRY FOOT CLINIC LOCATION42D2921723SC01
INTEGRATED HEALTH PLAN PROVIDERK066682SC01
NPI # MARK R KUTYLA DPM1326007022SC01
NPI # FOR MIDLANDS FOOT CLINIC - PRIMARY PRACTICE LOCATION1720032816SC01
MEDICARE RAILROAD PROVIDER480032059SC01
NPI # FOR NEWBERRY FOOT CLINIC - ADDITIONAL PRACTICE LOCATION1851338461SC01
ACM - NEWBERRY FOOT CLINIC1015587SC01
AETNA PROVIDER7238051SC01
CLIA CERTIFICATE OF WAIVER FOR MIDLANDS FOOT CLINIC LOCATION42D2021725SC01
CIGNA PROVIDER0433675SC01
ACM - MIDLANDS FOOT CLINIC1020003SC01



American Medical Association 2012 taxonomy code information

Code: 213ES0131X

Type:

Classification:



Definition:



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