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General NPI Number Information
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NPI Number | 1538866231
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Entity Type | Organization
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Legal Business Name | MUTNICK ALLERGY & ASTHMA, L.L.C.
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Dates
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Enumeration Date | 02/13/2023
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 9705 45TH AVE N
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City | MINNEAPOLIS
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State | MN
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Zip | 55442-2555
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Country | US
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Telephone | 714-296-6777
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Fax |
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Provider Business Mailing Address
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Address Line | 4920 UNDERWOOD LN N UNIT E
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City | PLYMOUTH
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State | MN
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Zip | 55442-4516
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACK MUTNICK
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Credential | MD
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Telephone | 714-296-6777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number |
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License Number State |
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