Theresa A Gutierrez, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

01053932A Issued in IN

Practice address

2810 Dupont Commerce CT
Fort Wayne, IN 46825-2393

Phone

(260) 490-7337

Fax

(260) 489-8937

NPI assigned

May 10, 2006

Last updated

Mar 18, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fort Wayne Pediatrics, PC

  • Pediatrics Physician
  • Fort Wayne, IN
  • NPI 1063595536
  NPD (past)
• Lima Memorial Joint Operating Company

  dba Lima Memorial Health System

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1144270380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2810 DUPONT COMMERCE CT",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468252393",
            "telephone_number": "260-490-7337",
            "fax_number": "260-489-8937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2810 DUPONT COMMERCE CT",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468252393",
            "telephone_number": "260-490-7337",
            "fax_number": "260-489-8937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUTIERREZ",
        "first_name": "THERESA",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-10",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01053932A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARMONY",
            "identifier": "233719",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000195595",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200332720",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Gura, DPT
• Mary Jo Gura, RN, WHNP-BC
• Megan Gurney, CMT
• Diane Nicole Gutgsell, PHARMD
• Naomi Guthrie
• David M Gutman, MD, FACG
• Sara Gutta
• Thomas E Gutwein, MD
• Jodi Lynn Guy, FNP-C
• Aleeza Guzman

• Pediatrics Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Pediatrics Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.