Provider Demographics
NPI:1821400896
Name:GUTNIK, ANIA
Entity Type:Individual
Prefix:MS
First Name:ANIA
Middle Name:
Last Name:GUTNIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 RAYMOND DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6720
Mailing Address - Country:US
Mailing Address - Phone:855-354-3337
Mailing Address - Fax:847-354-4939
Practice Address - Street 1:1901 RAYMOND DR
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-6720
Practice Address - Country:US
Practice Address - Phone:855-354-3337
Practice Address - Fax:847-354-4939
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203001647332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies