Provider Demographics
NPI:1699830539
Name:GUARISCO, MICHAEL PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PAUL
Last Name:GUARISCO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:844-630-0700
Mailing Address - Fax:877-374-1924
Practice Address - Street 1:1300 GAUSE BLVD STE C4
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-3041
Practice Address - Country:US
Practice Address - Phone:985-288-6419
Practice Address - Fax:877-889-8818
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017682207R00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA38199Medicaid
55157Medicare ID - Type Unspecified
LA38199Medicaid