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Individual

MR. ILYAS GUTALE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
600 E DIXIE AVE, LEESBURG, FL 34748-5925
(352) 323-5762
Mailing address
600 E DIXIE AVE, LEESBURG, FL 34748-5925
(352) 323-5762

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
PA1776
NV
363A00000X
Physician Assistant
54636
CA
363A00000X
Physician Assistant
MA053832
PA
363A00000X
Physician Assistant
Primary
PA1776
NV
363AM0700X
Medical Physician Assistant
PA 9105989
FL

Other

Enumeration date
01/23/2009
Last updated
04/25/2025
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