DR. JACK LEON-MAX MUTNICK (NPI# 1487601316) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487601316 |
| Entity Type | Individual |
| Full Name | DR. JACK LEON-MAX MUTNICK |
| Credential | M.D. |
| Practice Address |
1 W Lake St Minneapolis MN 55408-3154 |
| Mailing Address |
3440 Molina St Shakopee MN 55379-5444 |
| Practice Telephone | 6128232947 |
| Mailing Telephone | 7142966777 |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2020-05-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207K00000X | Allergy & Immunology | 48180 | MN | Allopathic & Osteopathic Physicians |
| N | 207R00000X | Internal Medicine | 48180 | MN | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1801 Nicollet Ave, Minneapolis, MN 554033791 | 6128232947 | |
| 3440 Molina St, Shakopee, MN 553795444 | 7142966777 |
| Street Address |
1 W LAKE ST |
| City | MINNEAPOLIS |
| State | MN |
| Zip Code | 55408-3154 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538726393 | Universal Medical Services, Inc | Clinic/Center | 1 W Lake St, Minneapolis, MN 55408-3154 | 2019-05-28 |
| 1033656053 | Mohamed Abdulle Farah | Clinic/Center | 1 W Lake St, Suite 125, Minneapolis, MN 55408-3154 | 2017-01-28 |
| 1073984902 | Focus Interpreter Service, LLC | Interpreter | 1 W Lake St, Suite 165, Minneapolis, MN 55408-3154 | 2015-10-19 |
| 1033547294 | Arthur Guzhagin | Chiropractor | 1 W Lake St, Suite 195, Minneapolis, MN 55408-3154 | 2013-10-28 |
| 1871872200 | Twin City Pain Center | Clinic/Center | 1 W Lake St, Minneapolis, MN 55408-3154 | 2011-08-16 |
| 1528354420 | Twin City Pain Center- West, Pllc | Anesthesiology | 1 W Lake St, Suite 195b, Minneapolis, MN 55408-3154 | 2011-06-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548870512 | Community Solutions Services Inc | Counselor | 3043 2nd Ave South, Suite 101, Minneapolis, MN 55408 | 2020-08-05 |
| 1356962740 | Mohammad Mushtaq Khandwala | Student in an Organized Health Care Education/Training Program | 2810 Nicollet Avenue South, Minneapolis, MN 55408 | 2020-04-27 |
| 1861012700 | Open Arms Group Home LLC | Nursing Care | 1 W Lake St Suite 165 Unit 7, Minneapolis, MN 55408 | 2020-04-21 |
| 1538710413 | Yuejuan Bian | Acupuncturist | 2743 Lyndale Ave S, Suite 2, Minneapolis, MN 55408 | 2019-09-23 |
| 1710536081 | Blu Care Inc | Clinic/Center | 2910 Pillsbury Ave S Ste 338, Minneapolis, MN 55408 | 2019-09-09 |
| 1417510165 | Kau Macador Queeglay | Counselor | 621 West Lake Street Suite 350 Lynlake Building, Minneapolis, MN 55408 | 2019-04-18 |
| 1346735875 | Nicole S Ehrenberg | Social Worker | 324 E 35th Street, Minneapolis, MN 55408 | 2018-06-27 |
| 1639681612 | American Family Transportation Inc | Non-emergency Medical Transport (VAN) | 2910 Pillsbury Ave So Suite 434, Minneapolis, MN 55408 | 2017-10-30 |
| 1285181743 | Multilingual Word Inc | Interpreter | 1431 W 32nd St, Minneapolis, MN 55408 | 2016-09-01 |
| 1376906388 | Sama Healthcare | Family Medicine | 2639 Nicollet Ave., Suite 130, Minneapolis, MN 55408 | 2016-03-29 |
| Find all providers in zip 55408 | ||||
| Taxonomy Code | 207K00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Allergy & Immunology |
| An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Selected examples of such conditions include asthma, anaphylaxis, rhinitis, eczema, and adverse reactions to drugs, foods, and insect stings as well as immune deficiency diseases (both acquired and congenital), defects in host defense, and problems related to autoimmune disease, organ transplantation, or malignancies of the immune system. |
| Notes: Source: American Board of Medical Specialties, 2007, www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Allergy and Immunology, 2007. http://www.abai.org/ No subspecialty certificates in allergy and immunology are offered by the American Board of Allergy and Immunology (ABAI). The ABAI, however, does offer formal special pathways for physicians seeking dual certification in allergy/immunology and pediatric pulmonology; allergy/immunology and pediatric rheumatology; and allergy/immunology and adult rheumatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518960095 | Hannelore August Brucker | Allergy & Immunology | 4010 W 65th St, Ste 221, Minneapolis, MN 55435-1706 | 2005-05-27 |
| 1720594500 | Paul Lorenz Bigliardi | Allergy & Immunology | 909 Fulton St Se Fl 3, Minneapolis, MN 55455-4800 | 2017-12-16 |
| 1083036222 | Gregory Paul Gilmet | Allergy & Immunology | 401 Harding St Ne # 100, Minneapolis, MN 55413-2801 | 2014-01-07 |
| 1154671873 | Manarmohammad Sharif Abdalgani | Allergy & Immunology | 2525 Chicago Ave, Minneapolis, MN 55404 | 2012-09-11 |
| 1477680718 | Southdale Allergy and Asthma Clinic, LLC | Allergy & Immunology | 4010 W 65th St, #221, Minneapolis, MN 55435-1721 | 2007-02-27 |
| 1881736544 | Eisenstadt Allergy & Asthma LLP | Allergy & Immunology | 825 Nicollet Mall, Suite 221, Minneapolis, MN 55402 | 2007-02-12 |
| 1295840783 | Nancy Lorene Ott | Allergy & Immunology | 2535 University Ave Se, Minneapolis, MN 55414-3205 | 2006-08-21 |
| 1912944489 | Malcolm Blumenthal | Allergy & Immunology | 825 S 8th St, M50, Minneapolis, MN 55404-1208 | 2006-06-01 |
| 1629031034 | Thomas Craig Eisenstadt | Allergy & Immunology | 825 Nicollet Mall, Suite 221 Eisenstadt Allergy & Asthma LLP, Minneapolis, MN 55426 | 2006-04-07 |
| 1689636482 | Ramarathinam Nagarajan | Allergy & Immunology | 825 Nicollet Mall, 221, Minneapolis, MN 55402 | 2006-04-05 |
| Find all providers in MINNEAPOLIS | ||||
| City | MINNEAPOLIS |
| Zip Code | 55408 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.