Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 213EP1101X | Podiatrist | Primary Podiatric Medicine | 516 | SOUTH CAROLINA | No |
| 2 | 213ER0200X | Podiatrist | Radiology | 516 | SOUTH CAROLINA | No |
| 3 | 213ES0000X | Podiatrist | Sports Medicine | 516 | SOUTH CAROLINA | No |
| 4 | 213ES0131X | Podiatrist | Foot Surgery | 516 | SOUTH CAROLINA | Yes |
| 5 | 2471M1202X | Radiologic Technologist | Magnetic Resonance Imaging | 516 | SOUTH CAROLINA | No |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 42D2921723 | OTHER | SOUTH CAROLINA | CLIA CERTIFICATE OF WAIVER FOR NEWBERRY FOOT CLINIC LOCATION |
| 2 | 1015587 | OTHER | SOUTH CAROLINA | ACM - NEWBERRY FOOT CLINIC |
| 3 | 1326007022 | OTHER | SOUTH CAROLINA | NPI # MARK R KUTYLA DPM |
| 4 | 7238051 | OTHER | SOUTH CAROLINA | AETNA PROVIDER |
| 5 | 1851338461 | OTHER | SOUTH CAROLINA | NPI # FOR NEWBERRY FOOT CLINIC - ADDITIONAL PRACTICE LOCATION |
| 6 | 480032059 | OTHER | SOUTH CAROLINA | MEDICARE RAILROAD PROVIDER |
| 7 | K066682 | OTHER | SOUTH CAROLINA | INTEGRATED HEALTH PLAN PROVIDER |
| 8 | 1720032816 | OTHER | SOUTH CAROLINA | NPI # FOR MIDLANDS FOOT CLINIC - PRIMARY PRACTICE LOCATION |
| 9 | 42D2021725 | OTHER | SOUTH CAROLINA | CLIA CERTIFICATE OF WAIVER FOR MIDLANDS FOOT CLINIC LOCATION |
| 10 | 1020003 | OTHER | SOUTH CAROLINA | ACM - MIDLANDS FOOT CLINIC |
| 11 | 0433675 | OTHER | SOUTH CAROLINA | CIGNA PROVIDER |
