Active NPI
Michael George Gutknecht, M.D.
- Diagnostic Radiology Physician
- Fort Myers, FL
National Provider Identifier
1629177514
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- G9747
- Practice address
- 3660 Broadway
Fort Myers, FL 33901-8005 - Phone
- (239) 936-2316
- Fax
- (239) 931-6373
- NPI assigned
- Sep 21, 2006
- 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 |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | G9747 | TX | Primary |
Addresses
Primary practice location
3660 Broadway
Fort Myers, FL 33901-8005
Mailing address
3660 Broadway
Fort Myers, FL 33901-8005
Phone (239) 936-2316
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 149VC | Other | FLORIDA BLUE CROSS | |
| 02271000 | Medicaid | FL |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G9747 | TX | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Providence Imaging Consultants, P.a. | Diagnostic Radiology | Past | Accepting new patients |
| Desert Imaging Services L P | Diagnostic Radiology | Past | Accepting new patients |
Networks
- Freedom Health HMO Network
Organizations & group practices 2
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.
-
- Diagnostic Radiology Physician
- El Paso, TX
- NPI 1659469344
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473811200000",
"number": "1629177514",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3660 BROADWAY",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339018005",
"telephone_number": "239-936-2316",
"fax_number": "239-931-6373"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3660 BROADWAY",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339018005",
"telephone_number": "239-936-2316",
"fax_number": "239-931-6373"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUTKNECHT",
"first_name": "MICHAEL",
"middle_name": "GEORGE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-21",
"last_updated": "2016-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "TX",
"license": "G9747",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FLORIDA BLUE CROSS",
"identifier": "149VC",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02271000",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Myers, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.