Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 4351040660 | MI |
NPI | 1033603105 |
---|---|
Provider Name | Nicholas Patrick Gut |
First Address | Grand Rapids, MI 49503-4502 |
Second Address | Grand Rapids, MI 49503-5247 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2018 |
Last Update Date | 10/07/2019 |