Provider Demographics
NPI:1720247646
Name:GUTEKUNST, HEATHER RIVERA (MD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:RIVERA
Last Name:GUTEKUNST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 603725
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3725
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:10880 DURANT RD
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6628
Practice Address - Country:US
Practice Address - Phone:919-846-0800
Practice Address - Fax:919-846-0880
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200800939207K00000X
NC2008-00939207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1720247646Medicaid
NCNC0584BOtherMEDICARE PTAN