Healthcare Provider Details

I. General information

NPI: 1043176076
Provider Name (Legal Business Name): MARC GUILLAUME
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2026
Last Update Date: 01/03/2026
Certification Date: 01/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 NW 55TH BLVD
GAINESVILLE FL
32653-2069
US

IV. Provider business mailing address

2715 NW 55TH BLVD
GAINESVILLE FL
32653-2069
US

V. Phone/Fax

Practice location:
  • Phone: 847-858-2691
  • Fax:
Mailing address:
  • Phone: 847-858-2691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: