Provider Demographics
NPI:1215248646
Name:GUO, XIAONAN MIA (DO)
Entity type:Individual
Prefix:
First Name:XIAONAN
Middle Name:MIA
Last Name:GUO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 CHESTER ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-4105
Mailing Address - Country:US
Mailing Address - Phone:248-709-2681
Mailing Address - Fax:
Practice Address - Street 1:31330 NORTHWESTERN HWY STE D
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2560
Practice Address - Country:US
Practice Address - Phone:248-918-2337
Practice Address - Fax:248-579-2406
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018884207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine