Healthcare Provider Details

I. General information

NPI: 1689613416
Provider Name (Legal Business Name): GUERCY SAINT-PHARD D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 W EMPIRE AVE
BENTON HARBOR MI
49022-7422
US

IV. Provider business mailing address

550 MAPLEWOOD CT. #F64
BERRIEN SPRINGS MI
49103-1381
US

V. Phone/Fax

Practice location:
  • Phone: 269-926-8535
  • Fax: 269-926-8528
Mailing address:
  • Phone: 269-471-6835
  • Fax: 269-926-8528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901002223
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: