Provider Demographics
NPI:1720961923
Name:MUTGI CONCIERGE NEUROLOGY AND CONSULTING
Entity type:Organization
Organization Name:MUTGI CONCIERGE NEUROLOGY AND CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-410-3856
Mailing Address - Street 1:30 N GOULD ST STE 11040
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-6317
Mailing Address - Country:US
Mailing Address - Phone:307-410-3856
Mailing Address - Fax:307-509-5461
Practice Address - Street 1:30 N GOULD ST STE 11040
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-6317
Practice Address - Country:US
Practice Address - Phone:307-410-3856
Practice Address - Fax:307-509-5461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty