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General NPI Number Information
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NPI Number | 1629874714
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Entity Type | Individual
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Provider Name | MICHAEL GUEVARA PARAMEDIC
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Gender | Male
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 1608 BLOOMINGDALE RD
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City | GLENDALE HEIGHTS
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State | IL
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Zip | 60139-2657
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Country | US
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Telephone | 630-668-5323
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Fax |
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Provider Business Mailing Address
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Address Line | 412 E 4TH ST
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City | LOCKPORT
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State | IL
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Zip | 60441-2924
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Country | US
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Telephone | 815-412-5571
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Fax |
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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 | 146L00000X
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Taxonomy Name | Paramedic
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License Number | 060373991
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License Number State | IL
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