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General NPI Number Information
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NPI Number | 1023002839
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Entity Type | Individual
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Provider Name | GLENN GUEVARRA RT
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Gender | Male
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Dates
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Enumeration Date | 09/07/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 9136A WAUKEGAN RD
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City | MORTON GROVE
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State | IL
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Zip | 60053-2119
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Country | US
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Telephone | 847-965-8890
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Fax | 847-965-5424
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Provider Business Mailing Address
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Address Line | 9136A WAUKEGAN RD
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City | MORTON GROVE
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State | IL
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Zip | 60053-2119
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Country | US
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Telephone | 847-965-8890
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Fax | 847-965-5424
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 227800000X
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Taxonomy Name | Certified Respiratory Therapist
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License Number |
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License Number State | IL
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