Provider Demographics
NPI:1639271356
Name:GUTMANN, ERNEST D (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:D
Last Name:GUTMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5015 N PAULINA ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2756
Mailing Address - Country:US
Mailing Address - Phone:773-275-4225
Mailing Address - Fax:773-275-7013
Practice Address - Street 1:5015 N PAULINA ST
Practice Address - Street 2:SUITE 204
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2756
Practice Address - Country:US
Practice Address - Phone:773-275-4225
Practice Address - Fax:773-275-7013
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21606041OtherBLUE CROSS BLUE SHIELD
IL81020OtherADVOCATE
ILP00060846OtherRAILROAD MEDICARE
IL21606041OtherBLUE CROSS BLUE SHIELD
IL485981Medicare ID - Type Unspecified