Healthcare Provider Details

I. General information

NPI: 1235796780
Provider Name (Legal Business Name): JOHN MICHAEL GUEST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21931 E 9 MILE RD
SAINT CLAIR SHORES MI
48080-2906
US

IV. Provider business mailing address

21931 E 9 MILE RD
SAINT CLAIR SHORES MI
48080-2906
US

V. Phone/Fax

Practice location:
  • Phone: 586-210-2464
  • Fax: 586-204-2473
Mailing address:
  • Phone: 586-210-2464
  • Fax: 586-204-2473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4351044538
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: