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NPI Code Detail

MEDICARE: MILTON G MUTCHNICK MD

MEDICARE: MILTON G MUTCHNICK MD
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
1207RG0100XGastroenterology Physician4301028211MI
2207R00000XInternal Medicine Physician4301028211MI

General Provider Information

NPI Number : 1407894579
Entity Type Code : Individual
Provider Name (Legal Business Name) : MILTON G MUTCHNICK MD
Provider Business Mailing Address
First Line : 400 MACK AVE
Second Line :
City : DETROIT
State : MI
Zip : 48201-2136
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4160 JOHN R ST STE 615
Second Line :
City : DETROIT
State : MI
Zip : 48201-2022
Country : US
Telephone Number : 313-745-4195
Fax Number : 313-993-8669
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2006
Last Update Date : 01/09/2026

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Directions to “ MILTON G MUTCHNICK MD” Practice Location

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