MEDICARE: MICHAEL V. GUADIZ MPT, D.D.S. PC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1356819817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL V. GUADIZ MPT, D.D.S. PC

Provider Business Mailing Address
First Line	:	1145 W TAYLOR ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-4221
Country	:	US
Telephone Number	:	312-226-1537
Fax Number	:	312-226-1536

Provider Business Practice Location Address
First Line	:	1145 W TAYLOR ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-4221
Country	:	US
Telephone Number	:	312-226-1537
Fax Number	:	312-226-1536

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. MICHAEL VINCENT GUADIZ
Credential	:
Telephone Number	:	312-226-1537

Provider Enumeration Date	:	11/02/2018
Last Update Date	:	11/02/2018

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