Provider Demographics
NPI:1609891563
Name:KUTTY, ITTAMVEETIL NARAYANAN (MD)
Entity type:Individual
Prefix:MR
First Name:ITTAMVEETIL
Middle Name:NARAYANAN
Last Name:KUTTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1167 SPRATLIN PARK DRIVE
Mailing Address - Street 2:FRONTIER HEALTH
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615
Mailing Address - Country:US
Mailing Address - Phone:423-467-3658
Mailing Address - Fax:423-467-3644
Practice Address - Street 1:2463 WILDWOOD DR
Practice Address - Street 2:STE 12
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-5800
Practice Address - Country:US
Practice Address - Phone:423-288-7869
Practice Address - Fax:423-392-6511
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD00000164942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA069097OtherBCBS
TN3016081Medicaid
TN0048066OtherBCBS
TN3701225Medicare ID - Type Unspecified
VA069097OtherBCBS