Provider Demographics
NPI:1891899373
Name:GUTOWICZ, MATTHEW F JR (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:F
Last Name:GUTOWICZ
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80985 SPANISH BAY
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-8607
Mailing Address - Country:US
Mailing Address - Phone:419-677-4354
Mailing Address - Fax:
Practice Address - Street 1:74785 HIGHWAY 111 SUITE V101 WALL ST WEST BLDG
Practice Address - Street 2:
Practice Address - City:INDIAN WELLS
Practice Address - State:CA
Practice Address - Zip Code:92210
Practice Address - Country:US
Practice Address - Phone:760-776-8989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4090207Q00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH300018971OtherRR MEDICARE
OH0341884Medicaid
GU7001532Medicare ID - Type Unspecified