Provider Demographics
NPI:1679656250
Name:MCCUTCHEON, CONRAD KYLE (MD)
Entity type:Individual
Prefix:DR
First Name:CONRAD
Middle Name:KYLE
Last Name:MCCUTCHEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9055 KATY FWY
Mailing Address - Street 2:SUITE 415
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1624
Mailing Address - Country:US
Mailing Address - Phone:281-822-3777
Mailing Address - Fax:281-822-3776
Practice Address - Street 1:9055 KATY FWY
Practice Address - Street 2:SUITE 415
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1624
Practice Address - Country:US
Practice Address - Phone:281-822-3777
Practice Address - Fax:281-822-3776
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH4534207YS0012X, 207YX0007X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A2492OtherBLUE CROSS BLUE SHIELD
F26649Medicare UPIN
TX8A2492Medicare PIN