=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558308957
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAYANTH K GUTTA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2006
-----------------------------------------------------
Last Update Date | 10/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 950 S MAIN ST SUITE 3
-----------------------------------------------------
City | CELINA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45822-2479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-586-3017
-----------------------------------------------------
Fax | 419-586-3174
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 830 W MAIN ST
-----------------------------------------------------
City | COLDWATER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45828-1626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 567-890-7143
-----------------------------------------------------
Fax | 419-586-0812
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | 35087081
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 35087081
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RS0012X
-----------------------------------------------------
Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 35-087081
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------