Provider Demographics
NPI:1821013855
Name:GUTEKUNST, CARL G (DO)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:G
Last Name:GUTEKUNST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:8235 HOLLY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2441
Mailing Address - Country:US
Mailing Address - Phone:810-694-9700
Mailing Address - Fax:810-694-9940
Practice Address - Street 1:8235 HOLLY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2441
Practice Address - Country:US
Practice Address - Phone:810-694-9700
Practice Address - Fax:810-694-9940
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2009-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101009463208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI105248OtherCARE CHOICES
MI0N89830002OtherBLUE CROSS MEDICARE ADVAN
MI112632786Medicaid
MI5250107OtherGENESEE HEALTH PLAN
MI020010629OtherPALMETTO GBA - RR MEDICAR
MI5250107OtherHEALTH PLUS
MI4111348OtherAETNA
MI5250107OtherBLUE CARE NETWORK
MIE79101OtherHAP
MI105248OtherPREFERRED CHOICE
MIC1666OtherMCARE
MI1015407OtherMCLAREN HEALTH PLAN
MI5250107OtherBLUE CROSS
MIC1666OtherMCARE