Healthcare Provider Details

I. General information

NPI: 1801641006
Provider Name (Legal Business Name): MICHAEL GOUTERMAN CP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 OWEN DR
FAYETTEVILLE NC
28304-3414
US

IV. Provider business mailing address

234 OWEN DR
FAYETTEVILLE NC
28304-3414
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-9016
  • Fax: 910-486-8712
Mailing address:
  • Phone: 910-323-9016
  • Fax: 910-486-8712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: