Provider Demographics
NPI:1558532721
Name:GUTOWSKI, WILLI DIETHELM (MD)
Entity Type:Individual
Prefix:
First Name:WILLI
Middle Name:DIETHELM
Last Name:GUTOWSKI
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:P.O. BOX 500409
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-0409
Mailing Address - Country:US
Mailing Address - Phone:670-234-8950
Mailing Address - Fax:
Practice Address - Street 1:1 LOWER NAVY HILL
Practice Address - Street 2:
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950-0409
Practice Address - Country:US
Practice Address - Phone:670-234-8950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP03362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry