Provider Demographics
NPI:1497817100
Name:GUGUCHEVA, KATIA (MD)
Entity Type:Individual
Prefix:DR
First Name:KATIA
Middle Name:
Last Name:GUGUCHEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 CHAPMAN CIR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-5953
Mailing Address - Country:US
Mailing Address - Phone:407-647-5037
Mailing Address - Fax:
Practice Address - Street 1:1449 CHAPMAN CIR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-5953
Practice Address - Country:US
Practice Address - Phone:407-647-5037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81002207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H03220Medicare UPIN