Provider Demographics
NPI:1083938708
Name:GUTIERREZ, LUIS ENRIQUE (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ENRIQUE
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4960 SW 72ND AVE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5544
Mailing Address - Country:US
Mailing Address - Phone:305-662-5200
Mailing Address - Fax:305-284-7948
Practice Address - Street 1:440 W 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3603
Practice Address - Country:US
Practice Address - Phone:305-828-5000
Practice Address - Fax:305-823-1635
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108014207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME108014OtherMEDICAL LICENSE