Provider Demographics
NPI:1134198799
Name:GUTOWSKI, KAROL A (MD)
Entity type:Individual
Prefix:
First Name:KAROL
Middle Name:A
Last Name:GUTOWSKI
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 1:1526 KITTYHAWK LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-7755
Mailing Address - Country:US
Mailing Address - Phone:773-870-0732
Mailing Address - Fax:847-780-1188
Practice Address - Street 1:2300 CHESTNUT AVE # 100
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1602
Practice Address - Country:US
Practice Address - Phone:773-870-0732
Practice Address - Fax:847-780-1188
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.121999208200000X
OH35122580208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0094902Medicaid
WI32142500Medicaid
OHH225780Medicare PIN
WI32142500Medicaid
G07136Medicare UPIN