Provider Demographics
NPI:1700806106
Name:GUTIERREZ, ALEXIS (MD)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:GUTIERREZ
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 1:13903 NW 67TH AVE
Mailing Address - Street 2:SUITE 440
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2939
Mailing Address - Country:US
Mailing Address - Phone:305-882-7747
Mailing Address - Fax:305-882-7748
Practice Address - Street 1:13903 NW 67TH AVENUE
Practice Address - Street 2:SUITE 440
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-2939
Practice Address - Country:US
Practice Address - Phone:305-882-7747
Practice Address - Fax:305-882-7748
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92389207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16399YMedicare PIN
FLI39375Medicare UPIN