Individual provider Active NPI

Milton G Mutchnick, MD

  • Gastroenterology Physician
  • Detroit, MI
National Provider Identifier
1407894579
Registry record updated Jan 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
4301028211 Issued in MI
Practice address
4160 John R St Ste 615
Detroit, MI 48201-2022
Phone
(313) 745-4195
Fax
(313) 993-8669
NPI assigned
Jun 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 4301028211 MI Primary
Internal Medicine Physician 207R00000X 4301028211 MI

Addresses

Primary practice location

4160 John R St Ste 615
Detroit, MI 48201-2022

Mailing address

400 Mack Ave
Detroit, MI 48201-2136

Other practice location 1

400 Mack Ave
Detroit, MI 48201-2136
Phone (313) 448-9650

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041102000916 MI Practitioner - Gastroenterology 5193637510 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Wayne State University School of Medicine, 1967
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Physician GroupGroup PAC ID 8628087681, 399 clinicians

Practice addresses (Care Compare)

4160 John R St
Suite 917
Detroit, MI 48201-2017
Phone (313) 745-7227

Hospital & facility affiliations

  • Harper University Hospital Hospital, Detroit, MI, CCN 230104
  • Detroit Receiving Hospital Hospital, Detroit, MI, CCN 230273
  • Karmanos Cancer Center Hospital, Detroit, MI, CCN 230297

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy17
Upper gastrointestinal (GI) endoscopy for acid reflux12

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301028211MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Physician Group CurrentSince Oct 1, 2006 Accepting new patients
University Physician Group Internal Medicine CurrentSince Oct 1, 2006 Accepting new patients
University Physician Group Past Accepting new patients
University Internal Medicine Specialists PastSince Nov 5, 2003 Accepting new patients

Locations

400 Mack Ave
Detroit, MI 48201
Phone (313) 448-9006

4160 John R St
Ste 615
Detroit, MI 48201
Phone (313) 745-5111

4201 Saint Antoine St
Ste 5B
Detroit, MI 48201
Phone (313) 745-1741

4160 John R St
Ste 917
Detroit, MI 48201
Phone (313) 745-1445

4100 John R St
Detroit, MI 48201
Phone (313) 576-8530

1560 E Maple Rd
Ste 400
Troy, MI 48083

1560 E Maple Rd
Ste 200
Troy, MI 48083
Phone (248) 581-5200

Interoperability endpoints

  • Direct secure messaging: milton.mutchnick.1@19711.direct.athenahealth.com
  • Direct secure messaging: mmutchni@direct.dmc.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767916800000",
    "number": "1407894579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 MACK AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4160 JOHN R ST STE 615",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012022",
            "telephone_number": "313-745-4195",
            "fax_number": "313-993-8669"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 Mack Ave",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482012136",
            "country_code": "US",
            "telephone_number": "313-448-9650",
            "fax_number": "313-448-9979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUTCHNICK",
        "first_name": "MILTON",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-02",
        "last_updated": "2026-01-09",
        "certification_date": "2026-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MI",
            "license": "4301028211",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301028211",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.