Individual
MITCHELL E NUTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1067 HAGER ST, GRAND LAKE OB/GYN, SAINT MARYS, OH 45885-2422
(419) 394-3387
(419) 394-7313
Mailing address
200 SAINT CLAIR STREET, GRAND LAKE PHYSICIAN PRACTICES, SAINT MARYS, OH 45885-2400
(419) 394-3387
(419) 394-7313
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
35.092080
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0204997
—
OH
01
—
1447288717
GROUP NPI
OH
01
—
9934724
MEDICARE GROUP PTAN LOCATION
OH
01
—
NU4097102
MEDICARE PTAN
OH
Enumeration date
07/18/2005
Last updated
01/02/2014
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