MEDICARE: JEANNE AMUTA M.D.

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	2085R0202X	Diagnostic Radiology Physician	264433	NY
2	2085R0202X	Diagnostic Radiology Physician	331625	LA
3	2085R0202X	Diagnostic Radiology Physician	35.143229	OH

General Provider Information

NPI Number	:	1265712129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNE AMUTA M.D.

Provider Business Mailing Address
First Line	:	13604 STARWREATH DR
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-3783
Country	:	US
Telephone Number	:	917-405-2323
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-1402
Country	:	US
Telephone Number	:	214-448-0212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2011
Last Update Date	:	08/10/2022

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