Provider Demographics
NPI:1679855084
Name:GUTZWILLER, JOE
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:GUTZWILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6166 DEERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-9161
Mailing Address - Country:US
Mailing Address - Phone:803-565-3575
Mailing Address - Fax:
Practice Address - Street 1:6166 DEERWOOD CT
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-9161
Practice Address - Country:US
Practice Address - Phone:803-565-3575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001704A246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other