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NPI Code Detail

MEDICARE: KORT GUILLETTE

MEDICARE: KORT GUILLETTE
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1407647506
Entity Type Code : Individual
Provider Name (Legal Business Name) : KORT GUILLETTE
Provider Business Mailing Address
First Line : 3 SAINT ELIZABETH BLVD STE 4000
Second Line :
City : O FALLON
State : IL
Zip : 62269-1284
Country : US
Telephone Number : 618-256-9355
Fax Number : 618-206-2332
Provider Business Practice Location Address
First Line : 3 SAINT ELIZABETH BLVD STE 4000
Second Line :
City : O FALLON
State : IL
Zip : 62269-1284
Country : US
Telephone Number : 618-256-9355
Fax Number : 618-206-2332
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2025
Last Update Date : 03/10/2026

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Directions to “ KORT GUILLETTE ” Practice Location

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