Provider Demographics
NPI:1972922466
Name:GUIRGUIS, JOHN KIMY DEMIAN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KIMY DEMIAN
Last Name:GUIRGUIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:720 2ND AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1778
Mailing Address - Country:US
Mailing Address - Phone:270-843-5114
Mailing Address - Fax:270-745-1230
Practice Address - Street 1:124 S UNIVERSITY BLVD STE A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3078
Practice Address - Country:US
Practice Address - Phone:251-343-5004
Practice Address - Fax:251-343-8383
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.024042207RI0008X
KY55563207RN0300X
AL48579207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY55563OtherKENTUCKY LICENSE