Healthcare Provider Details

I. General information

NPI: 1841493905
Provider Name (Legal Business Name): LUKE G. GUTWEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 100286
GAINESVILLE FL
32610-0286
US

IV. Provider business mailing address

6326 WASHINGTON BLVD
INDIANAPOLIS IN
46220-1730
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0680
  • Fax:
Mailing address:
  • Phone: 317-466-1494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number11430
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: