Provider Demographics
NPI:1689690158
Name:GUTOWSKI, SCOTT R (DO)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:R
Last Name:GUTOWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 OLDS ST
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49250-1128
Mailing Address - Country:US
Mailing Address - Phone:517-849-7100
Mailing Address - Fax:517-849-2453
Practice Address - Street 1:216 OLDS ST
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:MI
Practice Address - Zip Code:49250-1128
Practice Address - Country:US
Practice Address - Phone:517-849-7100
Practice Address - Fax:517-849-2453
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0120255OtherPHP
MI0853000175OtherBCBS
MIP00032160OtherRR MCR
MIGLHPOther143119
MI7537437OtherAETNA
MISG014795OtherBCN
MI7537437OtherAETNA
MIH46641Medicare UPIN