Individual
EDER GUTIERREZ CARLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
24 FRANK LLOYD WRIGHT DR, ANN ARBOR, MI 48105-9484
(734) 539-5000
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301504928
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/02/2018
Last updated
10/01/2021
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