Provider Demographics
NPI:1366470551
Name:GUO, DANZHU (MD)
Entity Type:Individual
Prefix:
First Name:DANZHU
Middle Name:
Last Name:GUO
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 1:1035 KEPLER DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-8320
Mailing Address - Country:US
Mailing Address - Phone:920-490-9046
Mailing Address - Fax:
Practice Address - Street 1:2401 HOLMGREN WAY
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5224
Practice Address - Country:US
Practice Address - Phone:920-288-8377
Practice Address - Fax:920-288-8385
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43199208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104365467Medicaid
WI34070400Medicaid
MI104981525Medicaid
WI250012454OtherRAILROAD
WI013107650Medicare ID - Type Unspecified
MI104365467Medicaid
MI104981525Medicaid