MEDICARE: DR. GUILLERMO J COUCHONNAL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	R9579	MO
2	207RI0200X	Infectious Disease Physician	0417557	KS

General Provider Information

NPI Number	:	1346223518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GUILLERMO J COUCHONNAL MD

Provider Business Mailing Address
First Line	:	1010 CARONDELET DR
Second Line	:	SUITE 329
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-4854
Country	:	US
Telephone Number	:	816-942-4755
Fax Number	:	816-942-1581

Provider Business Practice Location Address
First Line	:	1010 CARONDELET DR
Second Line	:	SUITE 329
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-4854
Country	:	US
Telephone Number	:	816-942-4755
Fax Number	:	816-942-1581

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	07/08/2007

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