Individual
ANDREW MUTISO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5000 KY RTE 321, PRESTONSBURG, KY 41653
(606) 886-7733
(606) 886-7400
Mailing address
PO BOX 390, HUNTINGTON, WV 25708
(304) 429-1088
(304) 429-3109
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
38249
KY
207P00000X
Emergency Medicine Physician
Primary
38249
KY
207Q00000X
Family Medicine Physician
38249
KY
208D00000X
General Practice Physician
38249
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64080815
—
KY
Enumeration date
12/08/2005
Last updated
10/14/2024
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