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NPI Code Detail

MEDICARE: MISS BRENDA M GUZMAN-VILLAR MD

MEDICARE: MISS BRENDA M GUZMAN-VILLAR MD
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
1208100000XPhysical Medicine & Rehabilitation PhysicianME119566FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P01393385OTHERFLRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3ME119566OTHERFLLICENSE
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710084041
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS BRENDA M GUZMAN-VILLAR MD
Provider Business Mailing Address
First Line : 401 NORTH MICHIGAN AVE
Second Line : 1200
City : CHICAGO
State : IL
Zip : 60611-4264
Country : US
Telephone Number : 312-635-0973
Fax Number : 813-290-9691
Provider Business Practice Location Address
First Line : 1919 LAKELAND HILLS BLVD
Second Line : PALM TERRACE OF LAKELAND
City : LAKELAND
State : FL
Zip : 33805-2901
Country : US
Telephone Number : 863-688-5612
Fax Number : 863-687-8870
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 10/26/2015

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