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General NPI Number Information
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NPI Number | 1699750059
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Entity Type | Individual
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Provider Name | ANDREW MUTISO MD
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Gender | Male
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Dates
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Enumeration Date | 12/08/2005
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 5000 KY RTE 321
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City | PRESTONSBURG
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State | KY
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Zip | 41653
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Country | US
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Telephone | 606-886-7733
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Fax | 606-886-7400
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Provider Business Mailing Address
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Address Line | PO BOX 390
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City | HUNTINGTON
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State | WV
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Zip | 25708
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Country | US
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Telephone | 304-429-1088
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Fax | 304-429-3109
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 38249
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 38249
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 38249
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 38249
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License Number State | KY
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