Basic Information
| Provider Information | |||||||||
| NPI: | 1457416554 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUTNER | ||||||||
| FirstName: | MORRIS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 S EVERS ST | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | PLANT CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335635403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137547756 | ||||||||
| FaxNumber: | 8137547565 | ||||||||
| Practice Location | |||||||||
| Address1: | 3058 HIGHLANDS BY THE LAKE WAY | ||||||||
| Address2: | #6 | ||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338125044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636871321 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 05/04/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | ME005867 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 12375 | 01 | FL | BCBS | OTHER | 0405441 | 01 | FL | EVERCARE | OTHER | 054685200 | 05 | FL | MEDICAID | 423475 | 01 | AETNA | OTHER | 380001598 | 01 | FL | MEDICARE RAILROAD | OTHER |