Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 209002478 | IL |
N | 363LA2100X | Nurse Practitioner - Acute Care | 209.002478 | IL |
NPI | 1013918598 |
---|---|
Provider Name | Thomas F. Gutchewsky |
First Address | Palos Heights, IL 60463-1290 |
Second Address | Palos Heights, IL 60463-1290 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 01/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F400287719 | MEDICARE PTAN (01) | IL |