Provider Demographics
NPI:1477852028
Name:DE GUZMAN, MARGRET DE JESUS (MD)
Entity Type:Individual
Prefix:MS
First Name:MARGRET
Middle Name:DE JESUS
Last Name:DE GUZMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:RED BUD ILLINOIS HOSPITAL COMANY LLC
Mailing Address - Street 2:325 SPRING ST
Mailing Address - City:RED BUD
Mailing Address - State:IL
Mailing Address - Zip Code:62278
Mailing Address - Country:US
Mailing Address - Phone:618-282-7373
Mailing Address - Fax:618-282-7376
Practice Address - Street 1:RED BUD ILLINOIS HOSPITAL COMANY LLC
Practice Address - Street 2:325 SPRING ST
Practice Address - City:RED BUD
Practice Address - State:IL
Practice Address - Zip Code:62278
Practice Address - Country:US
Practice Address - Phone:618-282-7373
Practice Address - Fax:618-282-7376
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036.148607208600000X
NC2018-02941208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program