MEDICARE: DR. ANDRE D. GUILLET D.P.M.

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	213E00000X	Podiatrist	005911	NY

General Provider Information

NPI Number	:	1205964962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDRE D. GUILLET D.P.M.

Provider Business Mailing Address
First Line	:	166 MIRIAM PKWY
Second Line	:
City	:	ELMONT
State	:	NY
Zip	:	11003-4429
Country	:	US
Telephone Number	:	516-770-9763
Fax Number	:

Provider Business Practice Location Address
First Line	:	148 WILSON AVENUE
Second Line	:	COMPREHENSIVE HEALTH CARE & REHABILATION SERVICES, LLC
City	:	BROOKLYN
State	:	NY
Zip	:	11237-3149
Country	:	US
Telephone Number	:	718-455-5500
Fax Number	:	718-455-8700

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	07/08/2007

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