MEDICARE: KIMBERLY X GUO 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	35.123013	OH
2	208000000X	Pediatrics Physician	4301096606	MI
3	207R00000X	Internal Medicine Physician	4301096606	MI

General Provider Information

NPI Number	:	1528220365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY X GUO M.D.

Provider Business Mailing Address
First Line	:	2150 MARBLE CLIFF OFFICE PARK STE B
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-1056
Country	:	US
Telephone Number	:	614-627-1640
Fax Number	:	614-299-6054

Provider Business Practice Location Address
First Line	:	2150 MARBLE CLIFF OFFICE PARK STE B
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-1056
Country	:	US
Telephone Number	:	614-627-1640
Fax Number	:	614-299-6054

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

Provider Enumeration Date	:	07/01/2008
Last Update Date	:	02/28/2022

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