Provider Demographics
NPI:1538141460
Name:GUIBOUX, JEAN-PAUL (MD)
Entity Type:Individual
Prefix:
First Name:JEAN-PAUL
Middle Name:
Last Name:GUIBOUX
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 1:3785 BAY RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2433
Mailing Address - Country:US
Mailing Address - Phone:989-791-2455
Mailing Address - Fax:989-791-1392
Practice Address - Street 1:26750 PROVIDENCE PARKWAY
Practice Address - Street 2:SUITE 220
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1233
Practice Address - Country:US
Practice Address - Phone:248-596-0412
Practice Address - Fax:248-596-0418
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058201207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG56742Medicare UPIN
MI400000770Medicare PIN
MI0N95100001Medicare PIN
MI5812140001Medicare NSC
MI0N95100Medicare PIN