MEDICARE: DR. STEPHEN T. H. GUTU M.D.

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	208000000X	Pediatrics Physician	40393	IA
2	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	40393	IA

General Provider Information

NPI Number	:	1528212594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN T. H. GUTU M.D.

Provider Business Mailing Address
First Line	:	2800 UNIVERSITY AVE STE 285
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1256
Country	:	US
Telephone Number	:	515-724-7637
Fax Number	:	515-724-7638

Provider Business Practice Location Address
First Line	:	2800 UNIVERSITY AVE STE 285
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1256
Country	:	US
Telephone Number	:	515-724-7637
Fax Number	:	515-724-7638

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2008
Last Update Date	:	05/26/2020

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