Provider Demographics
NPI:1629368162
Name:GUTIERREZ, JESUS (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:
Last Name:GUTIERREZ
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 1:702 BARNHILL DR
Mailing Address - Street 2:ROOM 5867
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5128
Mailing Address - Country:US
Mailing Address - Phone:317-948-0003
Mailing Address - Fax:
Practice Address - Street 1:702 BARNHILL DR
Practice Address - Street 2:RILEY CHILDREN'S HOSPITAL, MEDPEDS
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5128
Practice Address - Country:US
Practice Address - Phone:317-948-0003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program