Healthcare Provider Details

I. General information

NPI: 1689769044
Provider Name (Legal Business Name): GEORGE S MUTHALAKUZHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5344 9TH ST STE 107
ZEPHYRHILLS FL
33542-4348
US

IV. Provider business mailing address

PO BOX 2619
ZEPHYRHILLS FL
33539-2619
US

V. Phone/Fax

Practice location:
  • Phone: 813-724-3868
  • Fax: 813-724-3992
Mailing address:
  • Phone: 813-724-3868
  • Fax: 813-724-3992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 104902
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME104902
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME104902
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: