Provider Demographics
NPI:1154636777
Name:GUTMANOVICH, ARTEM (MD)
Entity type:Individual
Prefix:
First Name:ARTEM
Middle Name:
Last Name:GUTMANOVICH
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 1:290 174TH ST
Mailing Address - Street 2:2008
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3200
Mailing Address - Country:US
Mailing Address - Phone:847-877-3313
Mailing Address - Fax:
Practice Address - Street 1:413 PARADISE RD STE B
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-1332
Practice Address - Country:US
Practice Address - Phone:781-678-8144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125057536207Q00000X
FLME121037207Q00000X
MA1014651207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine