Provider Demographics
NPI:1477562643
Name:GUGGENHEIM, CARLA L (DO)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:L
Last Name:GUGGENHEIM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 N CEDAR ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-5334
Mailing Address - Country:US
Mailing Address - Phone:517-267-0107
Mailing Address - Fax:517-267-9523
Practice Address - Street 1:1106 N CEDAR ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-5334
Practice Address - Country:US
Practice Address - Phone:517-267-0107
Practice Address - Fax:517-267-9523
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICG010463207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1153302345OtherMICHIGAN BLUE SHIELD
MICG010463OtherSTATE LICENSE NUMBER
MI1004432OtherMCLAREN HEALTH PLAN
MI4233584Medicaid
MI3200009OtherPHYSICIANS HEALTH PLAN
MI4233584Medicaid
MICG010463OtherSTATE LICENSE NUMBER
MI0N15590Medicare PIN