Healthcare Provider Details

I. General information

NPI: 1134129620
Provider Name (Legal Business Name): JASON W. GUIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 CHARLESTOWN CROSSING WAY SUITE D
NEW ALBANY IN
47150
US

IV. Provider business mailing address

9800 SHELBYVILLE RD SUITE #220
LOUISVILLE KY
40223-2992
US

V. Phone/Fax

Practice location:
  • Phone: 812-945-5653
  • Fax: 502-429-6157
Mailing address:
  • Phone: 502-429-8585
  • Fax: 855-656-7325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number01057648A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number37904
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: