Basic Information
| Provider Information | |||||||||
| NPI: | 1699783225 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TUTUSKA | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 830 SW MULVANE ST | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666061654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852708625 | ||||||||
| FaxNumber: | 7852708624 | ||||||||
| Practice Location | |||||||||
| Address1: | 830 SW MULVANE ST | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666061654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852708625 | ||||||||
| FaxNumber: | 7852708624 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 02/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 04-22764 | KS | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 208G00000X | 04-22764 | KS | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 100115510B | 05 | KS | MEDICAID | 067339 | 01 | KS | MEDICARE PTAN | OTHER |