Provider Demographics
NPI:1104045822
Name:GUILIANO-KING, MICHELLE A (DPM)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:GUILIANO-KING
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:A
Other - Last Name:GUILIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:3773 UPPER COLD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05738-9512
Mailing Address - Country:US
Mailing Address - Phone:802-775-0966
Mailing Address - Fax:
Practice Address - Street 1:162 N MAIN ST # 10
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-3024
Practice Address - Country:US
Practice Address - Phone:802-775-2600
Practice Address - Fax:802-775-2662
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT056-0000176213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U80257Medicare UPIN