Individual
DR. THERESA A GUTIERREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2810 DUPONT COMMERCE CT, FORT WAYNE, IN 46825-2393
(260) 490-7337
(260) 489-8937
Mailing address
2810 DUPONT COMMERCE CT, FORT WAYNE, IN 46825-2393
(260) 490-7337
(260) 489-8937
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01053932A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000195595
ANTHEM
—
05
—
200332720
—
IN
01
—
233719
HARMONY
IN
Enumeration date
05/10/2006
Last updated
03/18/2021
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