Individual
DR. KEVIN ALLEN JUTZY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15855 NINETEEN MILE ROAD, EMERGENCY MEDICINE DEPARTMENT, CLINTON TWP, MI 48038-3504
(586) 263-2601
(586) 263-2589
Mailing address
38935 ANN ARBOR ROAD, CREDENTIALING/PAYER CONTRACTING SERVICES, LIVONIA, MI 48150-3397
(734) 632-0175
(734) 632-0182
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
4301086095
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11879585
CAQH
—
Enumeration date
05/18/2007
Last updated
07/15/2011
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