Provider Demographics
NPI:1376507079
Name:GUTMAN, DAVID M (MD, FACG)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:GUTMAN
Suffix:
Gender:M
Credentials:MD, FACG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 NORTHERN BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5200
Mailing Address - Country:US
Mailing Address - Phone:516-387-3990
Mailing Address - Fax:516-387-3990
Practice Address - Street 1:11109 PARKVIEW PLAZA DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1701
Practice Address - Country:US
Practice Address - Phone:260-373-9700
Practice Address - Fax:260-373-9740
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1745531207RG0100X
IN01083281A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D92237Medicare UPIN
NY02F881Medicare ID - Type Unspecified