Healthcare Provider Details

I. General information

NPI: 1508555087
Provider Name (Legal Business Name): ARIANNA GUTIERREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 07/04/2023
Certification Date: 07/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7435 W TALCOTT AVENUE
CHICAGO IL
60631-3746
US

IV. Provider business mailing address

7435 W TALCOTT AVENUE
CHICAGO IL
60631-3746
US

V. Phone/Fax

Practice location:
  • Phone: 773-792-5155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number125.081895
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: