MEDICARE: GERARDO GUZMAN

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	207Q00000X	Family Medicine Physician	036045045	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992739700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERARDO GUZMAN

Provider Business Mailing Address
First Line	:	1213 JOLIET ST
Second Line	:	SUITE E
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-3700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1213 JOLIET ST
Second Line	:	SUITE E
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-3700
Country	:	US
Telephone Number	:	630-231-7632
Fax Number	:

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	04/24/2008

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Directions to “ GERARDO GUZMAN ” Practice Location

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