Provider Demographics
NPI:1194861054
Name:GUEVARA, RAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:
Last Name:GUEVARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 E 86TH AVE STE Z
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6236
Mailing Address - Country:US
Mailing Address - Phone:219-769-0777
Mailing Address - Fax:219-755-0608
Practice Address - Street 1:521 E 86TH AVE STE Z
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6236
Practice Address - Country:US
Practice Address - Phone:219-769-0777
Practice Address - Fax:219-755-0608
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01079609A2084N0400X, 207WX0109X
TXL53522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ3021011OtherMEDICARE ID
TX157090501Medicaid
TX8E0378OtherMEDICARE ID