MEDICARE: JORGE A. 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	207ZN0500X	Neuropathology Physician	4301064067	MI
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	4301064067	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	JG064067	OTHER		COMMERCIAL-COMMERCIAL NUMBER
2	JG064067	OTHER		CHAMPUS-CHAMPUS

General Provider Information

NPI Number	:	1831247543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE A. GUTIERREZ M.D.

Provider Business Mailing Address
First Line	:	HENRY FORD HEALTH SYSTEM
Second Line	:	2799 WEST GRAND BOULEVARD
City	:	DETROIT
State	:	MI
Zip	:	48202
Country	:	US
Telephone Number	:	313-916-2436
Fax Number	:

Provider Business Practice Location Address
First Line	:	HENRY FORD HEALTH SYSTEM
Second Line	:	2799 WEST GRAND BOULEVARD
City	:	DETROIT
State	:	MI
Zip	:	48202
Country	:	US
Telephone Number	:	313-916-2436
Fax Number	:

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	09/11/2025

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