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General NPI Number Information
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NPI Number | 1306231410
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Entity Type | Individual
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Provider Name | NAGARAJAN MUTHU MD
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Gender | Male
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Dates
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Enumeration Date | 04/06/2015
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 1050 E BRANDON BLVD
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City | BRANDON
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State | FL
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Zip | 33511-5509
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Country | US
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Telephone | 813-694-1443
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Fax |
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Provider Business Mailing Address
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Address Line | 11850 MLK JR ST N APT 6210
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City | ST PETERSBURG
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State | FL
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Zip | 33716-1626
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Country | US
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Telephone | 586-872-9891
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME165295
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License Number State | FL
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