Provider Demographics
NPI:1851478036
Name:GUILLEN, JORGE (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:
Last Name:GUILLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JORGE
Other - Middle Name:
Other - Last Name:GUILLEN BASURCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8014 W 145TH TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-3342
Mailing Address - Country:US
Mailing Address - Phone:913-608-6875
Mailing Address - Fax:
Practice Address - Street 1:8101 PARALLEL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-2067
Practice Address - Country:US
Practice Address - Phone:913-899-9200
Practice Address - Fax:913-299-9210
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-32000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS171815Medicare PIN
KS171814Medicare PIN
KS171813Medicare PIN
KS171810Medicare PIN