Provider Demographics
NPI:1215133129
Name:GUILLAUME, TENNER JOHAN (MD)
Entity type:Individual
Prefix:DR
First Name:TENNER
Middle Name:JOHAN
Last Name:GUILLAUME
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Gender:M
Credentials:MD
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Mailing Address - Street 1:200 UNIVERSITY AVE E
Mailing Address - Street 2:GILLETTE CHILDREN'S SPECIALTY HEALTHCARE
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2507
Mailing Address - Country:US
Mailing Address - Phone:651-578-5197
Mailing Address - Fax:651-312-3188
Practice Address - Street 1:200 UNIVERSITY AVE E
Practice Address - Street 2:GILLETTE CHILDREN'S SPECIALTY HEALTHCARE
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2507
Practice Address - Country:US
Practice Address - Phone:651-578-5197
Practice Address - Fax:651-312-3188
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2011-12-01
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Provider Licenses
StateLicense IDTaxonomies
CAA99345207X00000X
MN53014207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery