Individual
DR. MARK RAYMOND KUTYLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
121 PARK PLACE CT, LEXINGTON, SC 29072-6690
(803) 356-4712
(803) 356-0832
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
516
SC
213ER0200X
Radiology Podiatrist
516
SC
213ES0000X
Sports Medicine Podiatrist
516
SC
213ES0131X
Foot Surgery Podiatrist
Primary
516
SC
2471M1202X
Magnetic Resonance Imaging Radiologic Technologist
516
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0433675
CIGNA PROVIDER
SC
01
—
1015587
ACM - NEWBERRY FOOT CLINIC
SC
01
—
1020003
ACM - MIDLANDS FOOT CLINIC
SC
01
—
1326007022
NPI # MARK R KUTYLA DPM
SC
01
—
1720032816
NPI # FOR MIDLANDS FOOT CLINIC - PRIMARY PRACTICE LOCATION
SC
01
—
1851338461
NPI # FOR NEWBERRY FOOT CLINIC - ADDITIONAL PRACTICE LOCATION
SC
01
—
42D2021725
CLIA CERTIFICATE OF WAIVER FOR MIDLANDS FOOT CLINIC LOCATION
SC
01
—
42D2921723
CLIA CERTIFICATE OF WAIVER FOR NEWBERRY FOOT CLINIC LOCATION
SC
01
—
480032059
MEDICARE RAILROAD PROVIDER
SC
01
—
7238051
AETNA PROVIDER
SC
01
—
K066682
INTEGRATED HEALTH PLAN PROVIDER
SC
Enumeration date
03/21/2006
Last updated
11/09/2020
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