Provider Demographics
NPI:1477592277
Name:ACHONG, GUILLERMO (MD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:
Last Name:ACHONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GUILLERMO
Other - Middle Name:
Other - Last Name:ACHONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:19601 WEST SAINT ANDREWS DRIVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33015
Mailing Address - Country:US
Mailing Address - Phone:305-829-7571
Mailing Address - Fax:
Practice Address - Street 1:3900 NW 79TH AVE STE 468
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6548
Practice Address - Country:US
Practice Address - Phone:305-829-7571
Practice Address - Fax:305-639-3377
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38304207VX0000X
FLME 38304208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD27900Medicare UPIN
FL95729Medicare ID - Type Unspecified