MEDICARE: DR. RAUL GUEVARA 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	2084N0400X	Neurology Physician	01079609A	IN
2	2084N0400X	Neurology Physician	L5352	TX
3	207WX0109X	Neuro-ophthalmology Physician	01079609A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	IN3021011	OTHER	IN	MEDICARE ID

General Provider Information

NPI Number	:	1194861054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAUL GUEVARA M.D.

Provider Business Mailing Address
First Line	:	521 E 86TH AVE STE Z
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-6236
Country	:	US
Telephone Number	:	219-769-0777
Fax Number	:	219-755-0608

Provider Business Practice Location Address
First Line	:	521 E 86TH AVE STE Z
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-6236
Country	:	US
Telephone Number	:	219-769-0777
Fax Number	:	219-755-0608

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	04/10/2024

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