Jerry M Mutua MD LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036062092 Issued in IL

Legal business name

JERRY M MUTUA MD LLC

Practice address

326 W 64TH St
Chicago, IL 60621-3114

Phone

(773) 994-5509

Fax

(773) 994-7405

NPI assigned

May 3, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Jerry M Mutua, M.D.

Title

Physician/Owner

Phone

(773) 994-5502

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1209772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238716800000",
    "number": "1467628073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6810 S EUCLID AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606491510",
            "telephone_number": "773-994-5509",
            "fax_number": "773-994-7405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "326 W 64TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606213114",
            "telephone_number": "773-994-5509",
            "fax_number": "773-994-7405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY M MUTUA MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-03",
        "last_updated": "2009-04-03",
        "status": "A",
        "authorized_official_last_name": "MUTUA",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "773-994-5502",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036062092",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036062092",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Barbara Jericho
• Caitlyn Jerkins, PHARMD
• Sara L Jerousek, CO, LO
• Jerrold Shapiro MD LTD
• Jerrold W. Smith D.D.S.P.C.
• Jerry Porzemsky, PH.D. P.C.
• Charles Michael Jersey
• Samantha Jerusal
• Marlye Jerva
• Ciera Jervier

• Family Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.