Provider Demographics
NPI:1164420006
Name:GUTMAN, MICHAEL BENTOV (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BENTOV
Last Name:GUTMAN
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 1:133 STEELE RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1047
Mailing Address - Country:US
Mailing Address - Phone:860-306-2609
Mailing Address - Fax:
Practice Address - Street 1:21 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1939
Practice Address - Country:US
Practice Address - Phone:860-236-3911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034589207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
930000597Medicare PIN
CTG06625Medicare UPIN