Provider Demographics
NPI:1295733301
Name:GUTHRIE, MICHAEL (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:GUTHRIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9523 BUSTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-3801
Mailing Address - Country:US
Mailing Address - Phone:215-710-8994
Mailing Address - Fax:267-428-6457
Practice Address - Street 1:9523 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3801
Practice Address - Country:US
Practice Address - Phone:215-710-8994
Practice Address - Fax:267-428-6457
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066100L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001932536000Medicaid
PA023583QL6Medicare PIN
PAG81446Medicare UPIN
PA001932536000Medicaid