Provider Demographics
NPI:1982703740
Name:GUTTER, GUIDO PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:GUIDO
Middle Name:PETER
Last Name:GUTTER
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 1:1020 PROFESSIONAL BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-8009
Mailing Address - Country:US
Mailing Address - Phone:812-477-8808
Mailing Address - Fax:812-477-9669
Practice Address - Street 1:1020 PROFESSIONAL BLVD
Practice Address - Street 2:STE.B
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-8009
Practice Address - Country:US
Practice Address - Phone:812-477-8808
Practice Address - Fax:812-477-9669
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240846208200000X
IN01067142A208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN253660FMedicare PIN