Basic Information
| Provider Information | |||||||||
| NPI: | 1891280087 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUTZNER | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | RYAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 MICHIGAN ST NE STE 300 | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495032537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163916243 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 221 MICHIGAN ST NE STE 300 | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495032537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163916243 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2018 | ||||||||
| LastUpdateDate: | 06/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 4301116131 | MI | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 4351043684 | MI | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.