Provider Demographics
NPI:1639144736
Name:GUYOT, LISA L (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:L
Last Name:GUYOT
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 HEALTH PARK BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7383
Mailing Address - Country:US
Mailing Address - Phone:810-606-7340
Mailing Address - Fax:810-606-7770
Practice Address - Street 1:841 HEALTH PARK BOULEVARD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-7383
Practice Address - Country:US
Practice Address - Phone:810-606-7340
Practice Address - Fax:810-606-7770
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2012-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILG063620207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1402510642OtherBLUE CROSS BLUE SHIELD
MI0992728OtherHEALTH PLUS
MI4568737Medicaid
GAP00090552OtherRAILROAD MEDICARE
GAP00090552OtherRAILROAD MEDICARE
0N84710Medicare ID - Type Unspecified