Provider Demographics
NPI:1033495668
Name:GUTMANN, MARY FARRELL (RD, MBA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:FARRELL
Last Name:GUTMANN
Suffix:
Gender:F
Credentials:RD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24230 KARIM BOULEVARD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2953
Mailing Address - Country:US
Mailing Address - Phone:248-919-1100
Mailing Address - Fax:248-919-1109
Practice Address - Street 1:24230 KARIM BOULEVARD
Practice Address - Street 2:SUITE 130
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2953
Practice Address - Country:US
Practice Address - Phone:248-919-1100
Practice Address - Fax:248-919-1109
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R603485133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered