Provider Demographics
NPI:1346327954
Name:GUZIEC, GARY J (DPM)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:J
Last Name:GUZIEC
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 N. WESTERN AVE.
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1775
Mailing Address - Country:US
Mailing Address - Phone:773-489-3313
Mailing Address - Fax:773-489-3441
Practice Address - Street 1:1431 N. WESTERN AVE.
Practice Address - Street 2:SUITE 210
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1775
Practice Address - Country:US
Practice Address - Phone:773-489-3313
Practice Address - Fax:773-489-3441
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003262213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL727882Medicare ID - Type Unspecified
ILT37733Medicare UPIN