Provider Demographics
NPI:1336550862
Name:GUTKOSKI, TYLER (MD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:GUTKOSKI
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 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-6255
Mailing Address - Fax:614-293-6265
Practice Address - Street 1:181 TAYLOR AVE FL 1
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1779
Practice Address - Country:US
Practice Address - Phone:614-293-6255
Practice Address - Fax:614-293-6265
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.138425207RN0300X
OH57.026763207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0146359Medicaid