Provider Demographics
NPI:1679599518
Name:GUTIERREZ, GERARDO (MD)
Entity type:Individual
Prefix:
First Name:GERARDO
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 1:75 REMITT DRIVE
Mailing Address - Street 2:LOCKBOX 1900
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-1900
Mailing Address - Country:US
Mailing Address - Phone:866-916-5259
Mailing Address - Fax:231-922-4030
Practice Address - Street 1:7245 RAIDER RD
Practice Address - Street 2:
Practice Address - City:BONNE TERRE
Practice Address - State:MO
Practice Address - Zip Code:63628-3767
Practice Address - Country:US
Practice Address - Phone:573-468-4186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046504A207P00000X
MO2001022240207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205762123Medicaid
MO205762107Medicaid
MO1679599518Medicaid
MO205762149Medicaid
MO106267A005OtherBLUE SHIELD
MO205762107Medicaid
MO205762149Medicaid
MO205762123Medicaid
MO022013213Medicare PIN
MO147480011Medicare PIN
MO028013209Medicare PIN
H45030Medicare UPIN
MO1679599518Medicaid
MO147400013Medicare PIN
MO027013211Medicare PIN