Provider Demographics
NPI:1407969181
Name:GUTTELING, EDWARD WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:WILLIAM
Last Name:GUTTELING
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 1:670 KEKUANAOA ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4405
Mailing Address - Country:US
Mailing Address - Phone:808-969-6152
Mailing Address - Fax:808-969-3728
Practice Address - Street 1:670 KEKUANAOA ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4405
Practice Address - Country:US
Practice Address - Phone:808-961-2609
Practice Address - Fax:808-969-3728
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 7826207XX0005X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI073105-04Medicaid
HIH55422Medicare PIN
E61096Medicare UPIN