Healthcare Provider Details

I. General information

NPI: 1720961923
Provider Name (Legal Business Name): MUTGI CONCIERGE NEUROLOGY AND CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

30 N GOULD ST STE 11040
SHERIDAN WY
82801-6317
US

IV. Provider business mailing address

30 N GOULD ST STE 11040
SHERIDAN WY
82801-6317
US

V. Phone/Fax

Practice location:
  • Phone: 307-410-3856
  • Fax: 307-509-5461
Mailing address:
  • Phone: 307-410-3856
  • Fax: 307-509-5461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EMMA MUTGI
Title or Position: CEO
Credential:
Phone: 307-410-3856