Provider Demographics
NPI:1790851897
Name:GUTMANN, JAMES E (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:GUTMANN
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:PO BOX 3868
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47737-3868
Mailing Address - Country:US
Mailing Address - Phone:812-426-9565
Mailing Address - Fax:812-426-9572
Practice Address - Street 1:8600 N KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-6302
Practice Address - Country:US
Practice Address - Phone:812-426-9565
Practice Address - Fax:812-426-9572
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036139A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000109433OtherANTHEM
IN100101700Medicaid
KY64872658OtherKY MEDICAID
IN100101700Medicaid
IN533890DMedicare PIN
IN257900NNNNMedicare PIN
KY64872658OtherKY MEDICAID