Provider Demographics
NPI:1801164710
Name:KUTCH, MICHAEL SHERMAN
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SHERMAN
Last Name:KUTCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4095 S HOHOKAM DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85650-8551
Mailing Address - Country:US
Mailing Address - Phone:520-378-7150
Mailing Address - Fax:
Practice Address - Street 1:4095 S HOHOKAM DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85650-8551
Practice Address - Country:US
Practice Address - Phone:520-378-7150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3364202385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child