Healthcare Provider Details

I. General information

NPI: 1689690158
Provider Name (Legal Business Name): SCOTT R GUTOWSKI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 OLDS ST
JONESVILLE MI
49250-1128
US

IV. Provider business mailing address

216 OLDS ST
JONESVILLE MI
49250-1128
US

V. Phone/Fax

Practice location:
  • Phone: 517-849-7100
  • Fax: 517-849-2453
Mailing address:
  • Phone: 517-849-7100
  • Fax: 517-849-2453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101014795
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: