Basic Information
| Provider Information | |||||||||
| NPI: | 1821075391 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUTTENPLAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1492 S MILL AVE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808945550 | ||||||||
| FaxNumber: | 4808949469 | ||||||||
| Practice Location | |||||||||
| Address1: | 1492 S MILL AVE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808945550 | ||||||||
| FaxNumber: | 7808949469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2005 | ||||||||
| LastUpdateDate: | 02/04/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | H7751 | TX | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 48133 | AZ | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 8H0731 | 01 | TX | BCBS | OTHER | 114231102 | 01 | TX | FIRSTCARE/SWLIFEHEALTH | OTHER | 8774426 | 05 | AZ | MEDICAID | 040017696 | 01 | TX | RR MEDICARE | OTHER |