MEDICARE: MICHAEL L GUTIERREZ MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	H8097	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356749642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL L GUTIERREZ MD PA

Provider Business Mailing Address
First Line	:	1009 E 40TH ST
Second Line	:	SUITE 300B
City	:	AUSTIN
State	:	TX
Zip	:	78751-4838
Country	:	US
Telephone Number	:	512-482-8280
Fax Number	:	512-482-9457

Provider Business Practice Location Address
First Line	:	1009 E 40TH ST
Second Line	:	SUITE 300B
City	:	AUSTIN
State	:	TX
Zip	:	78751-4838
Country	:	US
Telephone Number	:	512-482-8280
Fax Number	:	512-482-9457

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. MICHAEL LOUIS GUTIERREZ
Credential	:	MD
Telephone Number	:	512-482-8280

Provider Enumeration Date	:	12/18/2014
Last Update Date	:	06/06/2023

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