MEDICARE: MR. MICHAEL J GUIDRY MS

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	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1871761536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL J GUIDRY MS

Provider Business Mailing Address
First Line	:	1801 WINDMILL LN
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22307-1946
Country	:	US
Telephone Number	:	703-765-2442
Fax Number	:

Provider Business Practice Location Address
First Line	:	6521 ARLINGTON BLVD
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22042-3016
Country	:	US
Telephone Number	:	703-538-4161
Fax Number	:

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

Provider Enumeration Date	:	02/15/2008
Last Update Date	:	02/15/2008

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