Individual
DR. JERRY M MUTUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
326 W 64TH ST, ST. BERNARDS HOSPITAL, CHICAGO, IL 60621-3114
(773) 994-5502
(773) 994-7405
Mailing address
6810 S EUCLID AVE, CHICAGO, IL 60649-1510
(773) 994-5502
(773) 994-7405
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036062092
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036062092
—
IL
01
—
207Q0000X
TAXONOMY
IL
Enumeration date
04/05/2006
Last updated
02/25/2009
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