Provider Demographics
NPI:1528212594
Name:GUTU, STEPHEN T H (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:T H
Last Name:GUTU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2800 UNIVERSITY AVE STE 285
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1256
Mailing Address - Country:US
Mailing Address - Phone:515-724-7637
Mailing Address - Fax:515-724-7638
Practice Address - Street 1:2800 UNIVERSITY AVE STE 285
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1256
Practice Address - Country:US
Practice Address - Phone:515-724-7637
Practice Address - Fax:515-724-7638
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA40393208000000X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA175150159Medicare UPIN