Provider Demographics
NPI:1346223518
Name:COUCHONNAL, GUILLERMO J (MD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:J
Last Name:COUCHONNAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1010 CARONDELET DR
Mailing Address - Street 2:SUITE 329
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4854
Mailing Address - Country:US
Mailing Address - Phone:816-942-4755
Mailing Address - Fax:816-942-1581
Practice Address - Street 1:1010 CARONDELET DR
Practice Address - Street 2:SUITE 329
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4854
Practice Address - Country:US
Practice Address - Phone:816-942-4755
Practice Address - Fax:816-942-1581
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR9579207RI0200X
KS0417557207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0004282AMedicare ID - Type Unspecified
KS0004282BMedicare ID - Type Unspecified
C51658Medicare UPIN