Healthcare Provider Details

I. General information

NPI: 1619981545
Provider Name (Legal Business Name): MARTINA F. MUTONE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NINA MUTONE M.D.

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 E 138TH STE A
FISHERS IN
46037-0051
US

IV. Provider business mailing address

679 E COUNTY LINE RD
GREENWOOD IN
46143-1049
US

V. Phone/Fax

Practice location:
  • Phone: 317-813-1660
  • Fax: 317-813-1667
Mailing address:
  • Phone: 317-890-2000
  • Fax: 317-859-4269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number01050199A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01050199A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: