Provider Demographics
NPI:1043582158
Name:GUILLORY, JOEL ROY JR (M D)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:ROY
Last Name:GUILLORY
Suffix:JR
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4400 W 95TH ST
Mailing Address - Street 2:STE 205
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2654
Mailing Address - Country:US
Mailing Address - Phone:708-346-4040
Mailing Address - Fax:708-499-4312
Practice Address - Street 1:4400 W 95TH ST
Practice Address - Street 2:STE 205
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2654
Practice Address - Country:US
Practice Address - Phone:708-346-4040
Practice Address - Fax:708-499-4312
Is Sole Proprietor?:No
Enumeration Date:2012-02-04
Last Update Date:2012-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.049922208G00000X
IN01026803A208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)