Provider Demographics
NPI:1528026663
Name:GUGINO, GEORGE JOHN (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:JOHN
Last Name:GUGINO
Suffix:
Gender:M
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:PO BOX 394
Mailing Address - Street 2:1941 GATES ST
Mailing Address - City:REESE
Mailing Address - State:MI
Mailing Address - Zip Code:48757-0394
Mailing Address - Country:US
Mailing Address - Phone:989-868-4197
Mailing Address - Fax:989-868-3770
Practice Address - Street 1:1941 GATES ST
Practice Address - Street 2:
Practice Address - City:REESE
Practice Address - State:MI
Practice Address - Zip Code:48757-9555
Practice Address - Country:US
Practice Address - Phone:989-868-4197
Practice Address - Fax:989-868-3770
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGG024883208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1392012Medicaid
MI0793377Medicare ID - Type Unspecified
MIB44155Medicare UPIN