Provider Demographics
NPI:1871620518
Name:CUTLER, MICHAEL LARRY (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LARRY
Last Name:CUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17280
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4067
Mailing Address - Country:US
Mailing Address - Phone:760-622-2773
Mailing Address - Fax:
Practice Address - Street 1:12285 SCRIPPS POWAY PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-6149
Practice Address - Country:US
Practice Address - Phone:760-622-2773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51232207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTF83068Medicare UPIN