MEDICARE: GUILLOT ENTERPRISES LLC

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	261QH0700X	Hearing and Speech Clinic/Center	AS3293	FL

General Provider Information

NPI Number	:	1598130031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUILLOT ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	4130 NW 37TH PL
Second Line	:	SUITE C
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-8152
Country	:	US
Telephone Number	:	352-377-4111
Fax Number	:	352-367-1453

Provider Business Practice Location Address
First Line	:	9044 BONITA BEACH RD SE
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-4237
Country	:	US
Telephone Number	:	239-676-1651
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	THOMAS W GUILLOT
Credential	:	BC HIS
Telephone Number	:	352-377-4111

Provider Enumeration Date	:	12/09/2015
Last Update Date	:	03/11/2016

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Directions to “GUILLOT ENTERPRISES LLC ” Practice Location

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