| Jerry M Mutua Md Llc | |
|
326 W 64th St Chicago IL 60621-3114 | |
| (773) 994-5509 | |
| (773) 994-7405 |
| Full Name | Jerry M Mutua Md Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 326 W 64th St, Chicago, Illinois |
| Authorized Official Name and Position | Jerry M Mutua (PHYSICIAN/OWNER) |
| Authorized Official Contact | 7739945502 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jerry M Mutua Md Llc 6810 S Euclid Ave Chicago IL 60649-1510 Ph: (773) 994-5509 | Jerry M Mutua Md Llc 326 W 64th St Chicago IL 60621-3114 Ph: (773) 994-5509 |
| NPI Number | 1467628073 |
|---|---|
| Provider Enumeration Date | 05/03/2008 |
| Last Update Date | 04/03/2009 |
| Medicare PECOS PAC ID | 1658337928 |
|---|---|
| Medicare Enrollment ID | O20041208000492 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467628073 | NPI | - | NPPES |
| 036062092 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036062092 (Illinois) | Primary |
| Provider Name | Jerry M Mutua |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184686149 PECOS PAC ID: 8325003510 Enrollment ID: I20041130000378 |
| Provider Name | Mwia Mutua |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326434648 PECOS PAC ID: 2365795366 Enrollment ID: I20181022000068 |
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