Healthcare Provider Details

I. General information

NPI: 1245239235
Provider Name (Legal Business Name): STEPHEN V GUIDA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 NE 20TH TER STE 209
FT LAUDERDALE FL
33308-4510
US

IV. Provider business mailing address

4800 NE 20TH TER STE 209
FT LAUDERDALE FL
33308-4510
US

V. Phone/Fax

Practice location:
  • Phone: 954-776-1612
  • Fax: 954-776-1699
Mailing address:
  • Phone: 954-776-1612
  • Fax: 954-776-1699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO2047
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: