Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Jack Leon-Max Mutnick, MD

Individual provider Allergy & Immunology Physician · NPI 1487601316

Dr. Jack Leon-Max Mutnick, MD is an Allergy/Immunology in Edina, Minnesota. Graduated from University of Nevada School of Medicine in 2004, 22 years ago. Practices with Primary ENT, LLC, a 7-clinician group and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
22
Trained at
University of Nevada School of Medicine
Licensed in
MN
In the registry since
2006
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

3939 W 69th St Ste A
Edina, MN 55435-2001
Phone: (612) 930-8462
Fax: (800) 785-5608
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence 48180 (MN)
Allergy & Immunology Physician Taxonomy 207K00000X · Licence 48180 (MN)

Record details

NPI number1487601316
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMay 27, 2006
Last updated in NPPESDecember 11, 2024
Certification dateDecember 11, 2024
Mailing address3440 Molina St, Shakopee, MN 55379-5444

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyALLERGY/IMMUNOLOGY
Medical schoolUNIVERSITY OF NEVADA SCHOOL OF MEDICINE
Graduated 2004 (22 years in practice)
Group practice Primary Ent, L.L.C. — 7 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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