Provider Demographics
NPI:1780614966
Name:DR. ASTRID GUTSMANN PA
Entity type:Organization
Organization Name:DR. ASTRID GUTSMANN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ASTRID
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTSMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DO, PHD
Authorized Official - Phone:972-227-3464
Mailing Address - Street 1:411 E MCDERMOTT DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-2854
Mailing Address - Country:US
Mailing Address - Phone:972-227-3464
Mailing Address - Fax:877-879-2911
Practice Address - Street 1:411 E MCDERMOTT DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-2854
Practice Address - Country:US
Practice Address - Phone:972-227-3464
Practice Address - Fax:877-879-2911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0422207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0031NKOtherBCBS
TX181071501Medicaid
TX=========OtherCHAMPUS
TX181071501Medicaid
TXI53638Medicare UPIN