=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144153677
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GUERIN MICHAEL-RAE SZAFRANIEC DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2026
-----------------------------------------------------
Last Update Date | 06/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4840 23RD AVE S # 4805
-----------------------------------------------------
City | FARGO
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58104-9136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-234-6076
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4820 23RD AVE S STE 200
-----------------------------------------------------
City | FARGO
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58104-9138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-234-6076
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | RL24577
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------