Provider Demographics
NPI:1417268889
Name:CAROLYN E GUIDOT MD PC
Entity Type:Organization
Organization Name:CAROLYN E GUIDOT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:GUIDOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-642-8989
Mailing Address - Street 1:18161 W 13 MILE RD STE E1
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1113
Mailing Address - Country:US
Mailing Address - Phone:248-642-8989
Mailing Address - Fax:248-642-0756
Practice Address - Street 1:18161 W 13 MILE RD STE E1
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-1113
Practice Address - Country:US
Practice Address - Phone:248-642-8989
Practice Address - Fax:248-642-0756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047604207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A75439Medicare UPIN
0630431Medicare PIN