Provider Demographics
NPI:1013075704
Name:GUTIERREZ, MICHAEL ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 W OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80236-3108
Mailing Address - Country:US
Mailing Address - Phone:303-866-7054
Mailing Address - Fax:303-866-7197
Practice Address - Street 1:3520 W OXFORD AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80236-3108
Practice Address - Country:US
Practice Address - Phone:303-866-7054
Practice Address - Fax:303-866-7197
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31081207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01310812Medicaid
CO01310812Medicaid