MEDICARE: MUTHANNA LOUIS MD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1164702262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUTHANNA LOUIS MD PLLC

Provider Business Mailing Address
First Line	:	7455 GLENGROVE DR
Second Line	:
City	:	BLOOMFIELD
State	:	MI
Zip	:	48301-3871
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7455 GLENGROVE DR
Second Line	:
City	:	BLOOMFIELD
State	:	MI
Zip	:	48301-3871
Country	:	US
Telephone Number	:	248-798-7727
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MUTHANNA LOUIS
Credential	:	MD
Telephone Number	:	248-798-7727

Provider Enumeration Date	:	08/19/2011
Last Update Date	:	09/12/2011

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