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General NPI Number Information
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NPI Number | 1730708660
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Entity Type | Individual
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Provider Name | CALVIN LEROY GUTIERREZ MD
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Gender | Male
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Dates
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Enumeration Date | 04/10/2020
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 9200 W WISCONSIN AVE
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City | MILWAUKEE
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State | WI
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Zip | 53226-3522
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Country | US
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Telephone | 414-805-2060
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Fax | 414-259-9290
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Provider Business Mailing Address
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Address Line | 2263 SW 37TH AVE APT 436
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City | MIAMI
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State | FL
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Zip | 33145-3262
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Country | US
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Telephone | 407-414-2542
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME157042
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 86052
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License Number State | WI
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