Provider Demographics
NPI:1023532587
Name:GUTKIN, DARIA (DPM)
Entity type:Individual
Prefix:
First Name:DARIA
Middle Name:
Last Name:GUTKIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20905 E 12 MILE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-6501
Mailing Address - Country:US
Mailing Address - Phone:586-772-3500
Mailing Address - Fax:586-772-6540
Practice Address - Street 1:20905 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-6501
Practice Address - Country:US
Practice Address - Phone:586-772-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2025-05-12
Deactivation Date:2020-04-13
Deactivation Code:
Reactivation Date:2020-04-17
Provider Licenses
StateLicense IDTaxonomies
MI5901400504213ES0103X, 213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program