Active NPI
Katie Marie Mutke, MD
- Pediatric Critical Care Medicine Physician
- Milwaukee, WI
National Provider Identifier
1104445642
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Critical Care Medicine Physician
- License
- 83851-20
- Practice address
- 9000 W Wisconsin Ave # Ms 681
Milwaukee, WI 53226-4874 - Phone
- (414) 337-6773
- NPI assigned
- Apr 14, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Critical Care Medicine Physician | 2080P0203X | 83851-20 | WI | Primary |
Addresses
Primary practice location
9000 W Wisconsin Ave # Ms 681
Milwaukee, WI 53226-4874
Mailing address
9000 W Wisconsin Ave # Ms 681
Milwaukee, WI 53226-4874
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 83851-20 | WI | MD | Pediatric Critical Care Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1586822400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719187200000",
"number": "1104445642",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9000 W WISCONSIN AVE # MS 681",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532264874"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9000 W WISCONSIN AVE # MS 681",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532264874",
"telephone_number": "414-337-6773"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUTKE",
"first_name": "KATIE",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-04-14",
"last_updated": "2024-06-24",
"certification_date": "2024-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0203X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Critical Care Medicine",
"state": "WI",
"license": "83851-20",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.