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DR. JACK LEON-MAX MUTNICK M.D. NPI 1487601316


NPI Information

NPI: 1487601316
Provider Name: DR. JACK LEON-MAX MUTNICK, M.D.
Classification: Allergy & Immunology - 207K00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
4201 EXCELSIOR BLVD
ST LOUIS PARK, MN
ZIP 55416
Phone: (952) 933-8900
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DR. Jack Leon-max Mutnick, M.D. is an allergy immunology in St Louis Park, MN with 20 years of experience. The provider is an allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Selected examples of such conditions include asthma, anaphylaxis, rhinitis, eczema, and adverse reactions to drugs, foods, and insect stings as well as immune deficiency diseases (both acquired and congenital), defects in host defense, and problems related to autoimmune disease, organ transplantation, or malignancies of the immune system. DR. Jack Leon-max Mutnick, M.D. NPI is 1487601316. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF NEVADA SCHOOL OF MEDICINE
Graduation Year:2004

The provider's business location address is:

4201 EXCELSIOR BLVD
ST LOUIS PARK, MN
ZIP 55416-728
Phone: (952) 933-8900
Fax: (952) 945-9536

The NPI 1487601316 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/27/2006 and was last updated on 2/20/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207R00000XInternal Medicine48180MINNESOTANo
2207K00000XAllergy & Immunology48180MINNESOTAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.