Provider Demographics
NPI:1689769044
Name:MUTHALAKUZHY, GEORGE S (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:S
Last Name:MUTHALAKUZHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2619
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33539-2619
Mailing Address - Country:US
Mailing Address - Phone:813-724-3868
Mailing Address - Fax:813-724-3992
Practice Address - Street 1:12811 N NEBRASKA AVE STE I
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4401
Practice Address - Country:US
Practice Address - Phone:813-724-3868
Practice Address - Fax:813-724-3992
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 104902207R00000X
FLME104902208M00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001356600Medicaid
FLP01004046OtherMEDICARE RAILROAD PROVIDER NUMBER
FLP01004046OtherMEDICARE RAILROAD PROVIDER NUMBER
FLCH133UMedicare PIN