Provider Demographics
NPI:1285606442
Name:GUZMAN, ANDREW M (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6033 26TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-4402
Mailing Address - Country:US
Mailing Address - Phone:941-752-2025
Mailing Address - Fax:855-817-7456
Practice Address - Street 1:6033 26TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-4402
Practice Address - Country:US
Practice Address - Phone:941-752-2025
Practice Address - Fax:855-817-7456
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112905207V00000X
FLME113678207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112905Medicaid
K17845Medicare PIN
IL819300019Medicare PIN
IL036112905Medicaid