Provider Demographics
NPI:1730613621
Name:GUTOWSKI, MICHAL B (MD)
Entity type:Individual
Prefix:
First Name:MICHAL
Middle Name:B
Last Name:GUTOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1969 WEST HART RD
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-2283
Mailing Address - Country:US
Mailing Address - Phone:608-364-5689
Mailing Address - Fax:608-364-5452
Practice Address - Street 1:1905 EAST HUEBBE PARKWAY
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1842
Practice Address - Country:US
Practice Address - Phone:608-364-2200
Practice Address - Fax:608-265-8060
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI75178207W00000X
WI75178-20207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology