Provider Demographics
NPI:1831492339
Name:KAREN L. MUTTER, DO, PA
Entity Type:Organization
Organization Name:KAREN L. MUTTER, DO, PA
Other - Org Name:INTEGRATIVE MEDICINE HEALING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:MUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-524-0900
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:33760-3407
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:33760-3407
Practice Address - Country:US
Practice Address - Phone:727-524-0900
Practice Address - Fax:727-507-8822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 6328207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF05221Medicare UPIN