Provider Demographics
NPI:1710052006
Name:NUTIK, GORDON PHILIP (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:PHILIP
Last Name:NUTIK
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 1:4224 HOUMA BLVD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006
Mailing Address - Country:US
Mailing Address - Phone:504-456-8013
Mailing Address - Fax:504-456-8183
Practice Address - Street 1:4224 HOUMA BLVD
Practice Address - Street 2:SUITE 270
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-456-8013
Practice Address - Fax:504-456-8183
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014482207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1305294Medicaid
LA1305294Medicaid
LA54428Medicare ID - Type Unspecified