Provider Demographics
NPI:1730447251
Name:GUTMAN, STACEY LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:LYNN
Last Name:GUTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:24 MILES CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-4067
Mailing Address - Country:US
Mailing Address - Phone:207-563-4252
Mailing Address - Fax:759-323-6840
Practice Address - Street 1:512 SKYLINE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-1199
Practice Address - Country:US
Practice Address - Phone:218-879-4641
Practice Address - Fax:218-878-7081
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2024-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYR2933208600000X
MEMD21753208600000X
MN77119208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery