Doctor Name: | DR. CHRISTOPHER MATTHEW MUTTER |
NPI Number: | 1104231687 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | 5101022053 |
Business Practice Address: | 1000 Monroe Ave Nw Grand Rapids, MI - 495031455 |
Business Phone Number: | 6167326204 |
Business Fax Number: | |
Mailing Address: | 945 Ottawa Ave Nw, GRAND RAPIDS |
State: | MI |
Postal Code: | 495031431 |
Phone Number: | 6167326204 |
Fax Number: | |
NPI Enumeration Date: | 06/24/2014 |
NPI Last Update Date: | 10/16/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 5101022053 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |