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Contact Information

MARK R KUTYLA DPM PA
121 PARK PLACE CT
LEXINGTON, SC29072-6690
 Phone: 803-356-4712
 Fax: 803-356-0832
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Primary Podiatric Medicine

213EP1101X 48 Podiatry
 

Customized Equipment

332BC3200X 87 All Other Suppliers
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
 

Magnetic Resonance Imaging Radiologic Technologist

2471M1202X
 

Prosthetic/Orthotic Supplier

335E00000X 51 Medical Supply Company with Orthotist
 

Radiology

213ER0200X 48 Podiatry
 

Sports Medicine

213ES0000X 48 Podiatry
 

Surgery, Foot

213ES0131X 48 Podiatry
Indicates primary specialty

NPI Profile & details for MARK R KUTYLA DPM PA

NPI Number 1720032816
LBN Legal business name MARK R KUTYLA DPM PA
Authorized official MARK KUTYLA - (PRESIDENT)
Entity Organization
Organization subpart 1 Yes
Enumeration date 05/22/2006
Last updated 11/06/2011 - About 15 years ago
Identifiers
SC License # 516
SC Other 1020003 ACM # MIDLANDS FOOT CL.
SC Other 7238051 AETNA PROVIDER NO.
SC Other 42D2021725 CLIA CERTIFICATE OF WAIVER
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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