Healthcare Provider Details

I. General information

NPI: 1275718520
Provider Name (Legal Business Name): ROBERT G MUTCH DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 MAIN ST SUITE 3
MARLETTE MI
48453-1100
US

IV. Provider business mailing address

2750 MAIN ST SUITE 3
MARLETTE MI
48453-1100
US

V. Phone/Fax

Practice location:
  • Phone: 989-635-4023
  • Fax: 989-635-5297
Mailing address:
  • Phone: 989-635-4023
  • Fax: 989-635-5297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101013139
License Number StateMI

VIII. Authorized Official

Name: DR. ROBERT G MUTCH
Title or Position: PHYSICIAN/PRESIDENT
Credential: DO
Phone: 989-635-4023