Individual
MR. RICHARD KEVIN MCNUTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
900 S WEBSTER AVE, GREEN BAY, WI 54301-3508
(920) 965-7411
(920) 965-7412
Mailing address
PO BOX 13508, GREEN BAY, WI 54307-3508
(920) 965-7411
(920) 965-7412
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
27731
WI
2086S0129X
Vascular Surgery Physician
27731
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31707700
—
WI
Enumeration date
11/01/2006
Last updated
02/26/2013
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