Provider Demographics
NPI:1285671412
Name:GUERRERO, LEVI L (MD)
Entity Type:Individual
Prefix:
First Name:LEVI
Middle Name:L
Last Name:GUERRERO
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 1:3532 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DECKERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48427-9615
Mailing Address - Country:US
Mailing Address - Phone:810-376-3100
Mailing Address - Fax:810-376-8311
Practice Address - Street 1:3532 MAIN ST
Practice Address - Street 2:
Practice Address - City:DECKERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48427-9615
Practice Address - Country:US
Practice Address - Phone:810-376-3100
Practice Address - Fax:810-376-8311
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010038491208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103365954Medicaid
MI5067217OtherAETNA
MI0107600112OtherBC/BS/BC NETWORK
0M35930Medicare ID - Type Unspecified
MI5067217OtherAETNA