Provider Demographics
NPI:1881630119
Name:GUTIERREZ, MICHAEL M (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
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 1:7652 ASHLEY PARK CT
Mailing Address - Street 2:SUITE 305
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835
Mailing Address - Country:US
Mailing Address - Phone:407-299-7333
Mailing Address - Fax:407-293-2049
Practice Address - Street 1:7652 ASHLEY PARK CT
Practice Address - Street 2:SUITE 305
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835
Practice Address - Country:US
Practice Address - Phone:407-299-7333
Practice Address - Fax:407-293-2049
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50355207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03731OtherBCBS OF FL
FL064788800Medicaid
FLK8686Medicare ID - Type Unspecified