MEDICARE: DR. GLEN GUTTERSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	2021-01843	NC
2	207P00000X	Emergency Medicine Physician	C201031	CA
3	207P00000X	Emergency Medicine Physician	25MA10676100	NJ
4	207P00000X	Emergency Medicine Physician	292598	NY

General Provider Information

NPI Number	:	1205222528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLEN GUTTERSON M.D.

Provider Business Mailing Address
First Line	:	2213 CHERRY ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43608-2603
Country	:	US
Telephone Number	:	419-251-4724
Fax Number	:

Provider Business Practice Location Address
First Line	:	2213 CHERRY ST.
Second Line	:	ACC TRAUMA CLINIC
City	:	TOLEDO
State	:	OH
Zip	:	43608
Country	:	US
Telephone Number	:	419-251-4724
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2015
Last Update Date	:	05/05/2026

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