Provider Demographics
NPI:1982721684
Name:GUASTELLO, ELIZABETH MARIE (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE
Last Name:GUASTELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 W 4TH ST
Mailing Address - Street 2:SUITE 2050
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1328
Mailing Address - Country:US
Mailing Address - Phone:785-841-3636
Mailing Address - Fax:785-505-5210
Practice Address - Street 1:1130 W 4TH ST
Practice Address - Street 2:SUITE 2050
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1328
Practice Address - Country:US
Practice Address - Phone:785-841-3636
Practice Address - Fax:785-505-5210
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0436590207R00000X, 207RC0000X
MI4301087866207R00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program