Provider Demographics
NPI:1730172859
Name:KUTTENKULER, HEIDI B (DO)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:B
Last Name:KUTTENKULER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:BRANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:816-502-8752
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4401 WORNALL RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3220
Practice Address - Country:US
Practice Address - Phone:816-932-0340
Practice Address - Fax:816-932-3148
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-29948207R00000X, 208M00000X
MO2002029298207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
510610OtherFIRST GUARD
32019016OtherBCBS
KS100447380CMedicaid
32019016OtherBCBS
H43046Medicare UPIN
KSI14C106Medicare ID - Type Unspecified
KS100447380CMedicaid
32019016OtherBCBS
KSP00322293Medicare ID - Type UnspecifiedRR MCR
MOI14C106AMedicare ID - Type Unspecified
KS100447380CMedicaid
110248280Medicare ID - Type UnspecifiedRR MCR