Healthcare Provider Details

I. General information

NPI: 1548611981
Provider Name (Legal Business Name): LEVENT MUTLU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 HICKORY ST
MELBOURNE FL
32901-1973
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-752-0944
  • Fax: 321-434-7590
Mailing address:
  • Phone: 321-752-0944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberME167742
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: