Individual
PETER M SHUTKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
173 EAST AVENUE, NEW CANAAN, CT 06840
(203) 972-4255
(203) 801-2126
Mailing address
173 EAST AVENUE, NEW CANAAN, CT 06840
(203) 972-4255
(203) 801-2126
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
012542
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000121773201
UHC
—
01
—
00112542600
HUSKEY
—
01
—
01002542CT02
ANTHEM BC
—
01
—
4125199
AETNA
—
01
—
9519598002
CIGNA
—
01
—
ZPZ97
OXFORD
—
Enumeration date
11/21/2006
Last updated
07/08/2007
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