Healthcare Provider Details

I. General information

NPI: 1669651881
Provider Name (Legal Business Name): JORGE ENRIQUE GUZMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 NAPIER AVE
SAINT JOSEPH MI
49085-2112
US

IV. Provider business mailing address

85 MAUI LANI PKWY
WAILUKU HI
96793-2416
US

V. Phone/Fax

Practice location:
  • Phone: 269-985-4632
  • Fax:
Mailing address:
  • Phone: 808-442-5700
  • Fax: 808-442-5701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number48191
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036126808
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD-20060
License Number StateHI
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35.095151
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number57.013847
License Number StateOH
# 6
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number4301106886
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: