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NPI Code Detail

MEDICARE: DR. MITCH C TUTTLE M.D.

MEDICARE: DR. MITCH C TUTTLE 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
12085R0202XDiagnostic Radiology Physician83531GA
22085R0202XDiagnostic Radiology PhysicianME141405FL
32085R0202XDiagnostic Radiology Physician2014014264MO
42085R0202XDiagnostic Radiology Physician0101278607VA
52085R0202XDiagnostic Radiology PhysicianA154101CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710395314
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MITCH C TUTTLE M.D.
Provider Business Mailing Address
First Line : 5767 W CENTURY BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-5631
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3625 UNIVERSITY BLVD S
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-4207
Country : US
Telephone Number : 904-702-6111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2014
Last Update Date : 12/18/2025

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