MEDICARE: DR. DORIAN F GUERRA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036.120724	IL
2	208M00000X	Hospitalist Physician	036.120724	IL

General Provider Information

NPI Number	:	1053590430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DORIAN F GUERRA M.D.

Provider Business Mailing Address
First Line	:	1700 W VAN BUREN ST
Second Line	:	SUITE 500
City	:	CHICAGO
State	:	IL
Zip	:	60612-5500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1753 W CONGRESS PKWY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3838
Country	:	US
Telephone Number	:	312-942-4200
Fax Number	:	312-942-3568

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2007
Last Update Date	:	05/24/2022

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