Kenneth John Kutalek, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

26133 Issued in CO

Practice address

30960 Stagecoach Blvd
Suite W120
Evergreen, CO 80439-7902

Phone

(303) 674-6671

Fax

(303) 674-0031

NPI assigned

Jan 22, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kkutalek4811@direct.childrenscolorado.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Conifer Pediatrics

  • Pediatrics Physician
  • Conifer, CO
  • NPI 1265929814
  NPD Authorized official
• Evergreen Pediatrics, LLC

  • Pediatrics Physician
  • Evergreen, CO
  • NPI 1689839144
  NPD Authorized official
• Children'S Hospital Colorado

  • Clinical Social Worker
  • Aurora, CO
  • NPI 1174282776
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1346394152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30960 STAGECOACH BLVD",
            "address_2": "SUITE W120",
            "city": "EVERGREEN",
            "state": "CO",
            "postal_code": "804397902",
            "telephone_number": "303-674-6671",
            "fax_number": "303-674-0031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30960 STAGECOACH BLVD",
            "address_2": "SUITE W120",
            "city": "EVERGREEN",
            "state": "CO",
            "postal_code": "804397902",
            "telephone_number": "303-674-6671",
            "fax_number": "303-674-0031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUTALEK",
        "first_name": "KENNETH",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CO",
            "license": "26133",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01261338",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karen Braun Kooken, D.D.S.
• Nicole Kovac
• Michael Kraemer, LPC
• Joshua Dean Kuest, DPT
• Victor P. Kupfer, P.T.
• Laboratory Corporation of America
• Laboratory Corporation of America
• Chiu Mei Lai, DC
• Victoria Lamanna, DPT
• Jennifer Louise Larson, PHARMD

• Pediatrics Physician in Evergreen, CO
• Providers in Evergreen, CO by specialty
• Pediatrics Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.