Provider Demographics
NPI:1982610762
Name:UTZ, GARY L (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:UTZ
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 1:2600 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2102
Mailing Address - Country:US
Mailing Address - Phone:513-618-2848
Mailing Address - Fax:513-618-2849
Practice Address - Street 1:231 ALBERT SABIN WAY
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-0001
Practice Address - Country:US
Practice Address - Phone:513-558-4500
Practice Address - Fax:513-558-2289
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-0888207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11-01591OtherUNITED HEALTHCARE
OH7577600OtherAETNA
KY64083280Medicaid
OH2404946Medicaid
OH000000340748OtherANTHEM
OHUT4141131Medicare ID - Type Unspecified
OH2404946Medicaid