Provider Demographics
NPI:1881186609
Name:GUT-SHEPHERD, DOROTA (MD)
Entity Type:Individual
Prefix:DR
First Name:DOROTA
Middle Name:
Last Name:GUT-SHEPHERD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DOROTA
Other - Middle Name:
Other - Last Name:GUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:701 S HEALTH PKWY
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-8352
Mailing Address - Country:US
Mailing Address - Phone:269-273-6400
Mailing Address - Fax:269-273-9713
Practice Address - Street 1:701 S HEALTH PKWY
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-8352
Practice Address - Country:US
Practice Address - Phone:269-273-6400
Practice Address - Fax:269-273-9713
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1881186609207P00000X
IN01088663A207P00000X
MI4351036071390200000X
MI4301504387207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program