Individual
DR. JACK LEON-MAX MUTNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3939 W 69TH ST STE A, EDINA, MN 55435-2001
(612) 930-8462
(800) 785-5608
Mailing address
3440 MOLINA ST, SHAKOPEE, MN 55379-5444
(714) 296-6777
(800) 785-5608
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
48180
MN
207R00000X
Internal Medicine Physician
Primary
48180
MN
Other
Enumeration date
05/27/2006
Last updated
12/11/2024
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