MEDICARE: DANIEL GUTIERREZ 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	207R00000X	Internal Medicine Physician	036039895	IL

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	:	1801907548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL GUTIERREZ M.D.

Provider Business Mailing Address
First Line	:	13922 W CARRIAGE LN
Second Line	:
City	:	MANHATTAN
State	:	IL
Zip	:	60442-9564
Country	:	US
Telephone Number	:	815-740-7111
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 COPPERFIELD AVE
Second Line	:	SUITE 203
City	:	JOLIET
State	:	IL
Zip	:	60432-2054
Country	:	US
Telephone Number	:	815-727-4292
Fax Number	:	815-727-5395

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	05/08/2008

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