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General NPI Number Information
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NPI Number | 1801907548
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Entity Type | Individual
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Provider Name | DANIEL GUTIERREZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 05/08/2008
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Provider Practice Location Address
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Address Line | 1301 COPPERFIELD AVE SUITE 203
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City | JOLIET
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State | IL
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Zip | 60432-2054
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Country | US
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Telephone | 815-727-4292
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Fax | 815-727-5395
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Provider Business Mailing Address
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Address Line | 13922 W CARRIAGE LN
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City | MANHATTAN
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State | IL
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Zip | 60442-9564
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Country | US
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Telephone | 815-740-7111
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036039895
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License Number State | IL
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