Provider Demographics
NPI:1508491531
Name:PEDIATRIC NEUROLOGY DIVINE SOLUTIONS PLLC
Entity Type:Organization
Organization Name:PEDIATRIC NEUROLOGY DIVINE SOLUTIONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:T H
Authorized Official - Last Name:GUTU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-724-7637
Mailing Address - Street 1:974 73RD ST STE 25
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-1026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:974 73RD ST STE 25
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-1026
Practice Address - Country:US
Practice Address - Phone:515-724-7637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty