Healthcare Provider Details

I. General information

NPI: 1477562643
Provider Name (Legal Business Name): CARLA L GUGGENHEIM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 N CEDAR ST SUITE 2A
LANSING MI
48906-5334
US

IV. Provider business mailing address

1106 N CEDAR ST SUITE 2A
LANSING MI
48906-5334
US

V. Phone/Fax

Practice location:
  • Phone: 517-267-0107
  • Fax: 517-267-9523
Mailing address:
  • Phone: 517-267-0107
  • Fax: 517-267-9523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberCG010463
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: