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Kenneth Mutia
NPI 1518792704 · on the registry since 2024
Practice
- Address
- 11050 Mt Belvedere Blvd
Fort Drum, NY 13602 - Phone
- (315) 772-8813
- Organisation at this address
- Bobbi Petranchuk
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 116
Registry record
- Primary taxonomy
- 363A00000X
363A00000X
- Licence states on file
- NULL
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2025-12-16
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in New York