MEDICARE: MICHAEL GUEVARA PARAMEDIC

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	146L00000X	Paramedic	060373991	IL

General Provider Information

NPI Number	:	1629874714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL GUEVARA PARAMEDIC

Provider Business Mailing Address
First Line	:	412 E 4TH ST
Second Line	:
City	:	LOCKPORT
State	:	IL
Zip	:	60441-2924
Country	:	US
Telephone Number	:	815-412-5571
Fax Number	:

Provider Business Practice Location Address
First Line	:	1608 BLOOMINGDALE RD
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-2657
Country	:	US
Telephone Number	:	630-668-5323
Fax Number	:

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

Provider Enumeration Date	:	02/20/2025
Last Update Date	:	02/20/2025

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