Provider Demographics
NPI:1417917006
Name:MUTCHNIK, DAVID L (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:MUTCHNIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9669 KENTON AVE
Mailing Address - Street 2:SUITE 608
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1266
Mailing Address - Country:US
Mailing Address - Phone:847-677-4111
Mailing Address - Fax:847-677-3343
Practice Address - Street 1:9669 KENTON AVE
Practice Address - Street 2:SUITE 608
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1266
Practice Address - Country:US
Practice Address - Phone:847-677-4111
Practice Address - Fax:847-677-3343
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036038702208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036038702Medicaid
ILC38199Medicare UPIN
ILK20434Medicare ID - Type UnspecifiedSKOKIE
ILK20433Medicare ID - Type UnspecifiedHIGHLAND PARK