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NPI Code Detail

MEDICARE: JEAN WILSON MUTAMBUZE MD

MEDICARE: JEAN WILSON MUTAMBUZE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician01093511AIN
2390200000XStudent in an Organized Health Care Education/Training Program11021974AIN

General Provider Information

NPI Number : 1518427905
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEAN WILSON MUTAMBUZE MD
Provider Business Mailing Address
First Line : 9998 CROSSPOINT BLVD STE 200
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46256-3307
Country : US
Telephone Number : 317-579-2150
Fax Number : 317-579-2130
Provider Business Practice Location Address
First Line : 9998 CROSSPOINT BLVD STE 200
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46256-3307
Country : US
Telephone Number : 317-579-2150
Fax Number : 317-579-2130
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2019
Last Update Date : 02/13/2026

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Directions to “ JEAN WILSON MUTAMBUZE MD” Practice Location

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