Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RN0300X | Nephrologist | 005280 | AZ |
Y | 207RN0300X | Nephrologist | 5101016246 | MI |
NPI | 1013077866 |
---|---|
Provider Name | Dr. Jeffrey Michael Gutman |
First Address | Detroit, MI 48277-2000 |
Second Address | Allen Park, MI 48101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 30/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
450852 | (05) | AZ |