Provider Demographics
NPI:1053445155
Name:GUTIERREZ, MAE (MD)
Entity Type:Individual
Prefix:DR
First Name:MAE
Middle Name:
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 1:580 CRANDON BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149-1832
Mailing Address - Country:US
Mailing Address - Phone:305-361-8200
Mailing Address - Fax:
Practice Address - Street 1:580 CRANDON BLVD STE 101
Practice Address - Street 2:
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149-1832
Practice Address - Country:US
Practice Address - Phone:305-361-8200
Practice Address - Fax:305-361-8005
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 98559207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME98559OtherMEDICAL LICENSE
FLME 98559OtherMEDICAL LICENSE