Provider Demographics
NPI:1083683783
Name:GUINN, BRETT J (MD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:J
Last Name:GUINN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6920 POINTE INVERNESS WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3514
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:2510 E DUPONT RD STE 210
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1602
Practice Address - Country:US
Practice Address - Phone:260-458-3710
Practice Address - Fax:260-458-3714
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2020-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01051358A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200242270Medicaid
H01412Medicare UPIN
IN200242270Medicaid
IN239250CMedicare PIN
INP01520793OtherRAILROAD MEDICARE
IN200242270Medicaid
IN100226060BMedicaid