Provider Demographics
NPI:1518745652
Name:MUTCHIE, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MUTCHIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ANSEL LN
Mailing Address - Street 2:
Mailing Address - City:NORTH YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04097-6341
Mailing Address - Country:US
Mailing Address - Phone:207-331-9166
Mailing Address - Fax:
Practice Address - Street 1:9 ANSEL LN
Practice Address - Street 2:
Practice Address - City:NORTH YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04097-6341
Practice Address - Country:US
Practice Address - Phone:207-331-9166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant