Provider Demographics
NPI:1962516633
Name:GARY J GUZIEC DPM LTD
Entity type:Organization
Organization Name:GARY J GUZIEC DPM LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GUZIEC
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-489-3313
Mailing Address - Street 1:1431 N WESTERN AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1797
Mailing Address - Country:US
Mailing Address - Phone:773-489-3313
Mailing Address - Fax:773-489-3441
Practice Address - Street 1:1431 N WESTERN AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1797
Practice Address - Country:US
Practice Address - Phone:773-489-3313
Practice Address - Fax:773-489-3441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2680097OtherCIGNA PROVIDER NUMBER
IL60021251OtherBCBS PROVIDER NUMBER
IL4521802OtherAETNA PROVIDER NUMBER
IL=========OtherTIN
IL727882Medicare ID - Type Unspecified
ILT37733Medicare UPIN