Provider Demographics
NPI:1821075391
Name:GUTTENPLAN, MICHAEL DAVID (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:GUTTENPLAN
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 1:1492 S MILL AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281
Mailing Address - Country:US
Mailing Address - Phone:480-894-5550
Mailing Address - Fax:480-894-9469
Practice Address - Street 1:1492 S MILL AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281
Practice Address - Country:US
Practice Address - Phone:480-894-5550
Practice Address - Fax:780-894-9469
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7751207Y00000X
AZ48133207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8H0731OtherBCBS
TX114231102OtherFIRSTCARE/SWLIFEHEALTH
AZ8774426Medicaid
TX040017696OtherRR MEDICARE
TXE64882Medicare UPIN
AZ8774426Medicaid
E64882Medicare UPIN