Provider Demographics
NPI:1265470892
Name:MUTTER, KAREN LISA (DO)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LISA
Last Name:MUTTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5771 ROOSEVELT BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-3413
Mailing Address - Country:US
Mailing Address - Phone:727-524-0900
Mailing Address - Fax:727-507-8822
Practice Address - Street 1:5771 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3413
Practice Address - Country:US
Practice Address - Phone:727-524-0900
Practice Address - Fax:727-507-8822
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 6328207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80679BMedicare ID - Type Unspecified
FLF05221Medicare UPIN