Provider Demographics
NPI:1053690099
Name:GUTNIK, LILY (MD MPH)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:GUTNIK
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 7TH AVE S # BDB515
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1912
Mailing Address - Country:US
Mailing Address - Phone:646-289-2524
Mailing Address - Fax:
Practice Address - Street 1:1808 7TH AVE S BDB515
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-2401
Practice Address - Country:US
Practice Address - Phone:205-975-5477
Practice Address - Fax:205-975-5971
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL430832086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty