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General NPI Number Information
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NPI Number | 1639144736
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Entity Type | Individual
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Provider Name | LISA L GUYOT MD PHD
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Gender | Female
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 09/15/2012
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Provider Practice Location Address
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Address Line | 841 HEALTH PARK BOULEVARD
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City | GRAND BLANC
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State | MI
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Zip | 48439-7383
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Country | US
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Telephone | 810-606-7340
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Fax | 810-606-7770
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Provider Business Mailing Address
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Address Line | 841 HEALTH PARK BOULEVARD
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City | GRAND BLANC
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State | MI
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Zip | 48439-7383
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Country | US
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Telephone | 810-606-7340
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Fax | 810-606-7770
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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 | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | LG063620
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License Number State | MI
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