Provider Demographics
NPI:1306958509
Name:GUTTENPLAN, MITCHEL (MD)
Entity type:Individual
Prefix:DR
First Name:MITCHEL
Middle Name:
Last Name:GUTTENPLAN
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 1:4040 LAKE WASHINGTON BLVD NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-7874
Mailing Address - Country:US
Mailing Address - Phone:425-284-7890
Mailing Address - Fax:425-284-7896
Practice Address - Street 1:755 MOUNT VERNON HWY NE
Practice Address - Street 2:SUITE 350
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4274
Practice Address - Country:US
Practice Address - Phone:404-943-9579
Practice Address - Fax:404-943-9970
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA25166208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD29642Medicare UPIN