Healthcare Provider Details

I. General information

NPI: 1841262771
Provider Name (Legal Business Name): JOHN A. GUZZO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2006
Last Update Date: 03/07/2023
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12800 MISSISSIPPI PKWY
CROWN POINT IN
46307-6900
US

IV. Provider business mailing address

601 GATEWAY BLVD N
CHESTERTON IN
46304-9658
US

V. Phone/Fax

Practice location:
  • Phone: 219-921-1444
  • Fax: 219-921-5303
Mailing address:
  • Phone: 219-921-1444
  • Fax: 219-921-0533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number01073893A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: