MEDICARE: DR. ERNEST D. GUTMANN MD

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	207W00000X	Ophthalmology Physician		IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00060846	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21606041	OTHER	IL	BLUE CROSS BLUE SHIELD
2	81020	OTHER	IL	ADVOCATE

General Provider Information

NPI Number	:	1639271356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERNEST D. GUTMANN MD

Provider Business Mailing Address
First Line	:	5015 N PAULINA ST
Second Line	:	SUITE 204
City	:	CHICAGO
State	:	IL
Zip	:	60640-2756
Country	:	US
Telephone Number	:	773-275-4225
Fax Number	:	773-275-7013

Provider Business Practice Location Address
First Line	:	5015 N PAULINA ST
Second Line	:	SUITE 204
City	:	CHICAGO
State	:	IL
Zip	:	60640-2756
Country	:	US
Telephone Number	:	773-275-4225
Fax Number	:	773-275-7013

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	07/08/2007

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