Provider Demographics
NPI:1033467626
Name:GUTIERREZ, ANITA FICSOR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:FICSOR
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26648 COUNTY ROAD 653
Mailing Address - Street 2:
Mailing Address - City:GOBLES
Mailing Address - State:MI
Mailing Address - Zip Code:49055
Mailing Address - Country:US
Mailing Address - Phone:269-628-4005
Mailing Address - Fax:
Practice Address - Street 1:26648 COUNTY ROAD 653
Practice Address - Street 2:
Practice Address - City:GOBLES
Practice Address - State:MI
Practice Address - Zip Code:49055
Practice Address - Country:US
Practice Address - Phone:269-628-4005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060041207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine