Active NPI
Michael Gutzeit, M.D.
- Pediatrics Physician
- New Berlin, WI
National Provider Identifier
1104813328
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 27646
- Practice address
- 4855 S Moorland Rd Ste 250
New Berlin, WI 53151-7494 - Phone
- (262) 789-6020
- Fax
- (262) 789-6025
- NPI assigned
- Oct 3, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 27646 | WI | Primary |
Addresses
Primary practice location
4855 S Moorland Rd Ste 250
New Berlin, WI 53151-7494
Mailing address
3610 Michelle Witmer Memorial Dr
Suite 100
New Berlin, WI 53151-5292
Phone (262) 789-6020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31398800 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27646 | WI | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children'S Medical Group | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- mgutzeit7834@direct.chw.org
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatrics Physician
- Glendale, WI
- NPI 1134394471
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1104813328",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3610 MICHELLE WITMER MEMORIAL DR",
"address_2": "SUITE 100",
"city": "NEW BERLIN",
"state": "WI",
"postal_code": "531515292",
"telephone_number": "262-789-6020",
"fax_number": "262-789-6025"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4855 S MOORLAND RD STE 250",
"city": "NEW BERLIN",
"state": "WI",
"postal_code": "531517494",
"telephone_number": "262-789-6020",
"fax_number": "262-789-6025"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUTZEIT",
"first_name": "MICHAEL",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-03",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WI",
"license": "27646",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "31398800",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in New Berlin, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.