Provider Demographics
NPI:1659431658
Name:GUNO, NESTOR MENDOZA (MD)
Entity Type:Individual
Prefix:DR
First Name:NESTOR
Middle Name:MENDOZA
Last Name:GUNO
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 507
Mailing Address - Street 2:
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-0507
Mailing Address - Country:US
Mailing Address - Phone:989-348-6363
Mailing Address - Fax:989-348-6111
Practice Address - Street 1:114 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738-1741
Practice Address - Country:US
Practice Address - Phone:989-348-6363
Practice Address - Fax:989-348-6111
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MING033010207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2927002Medicaid
MI0102000422OtherBLUE CROSS
MIB46816Medicare UPIN
MI06919211Medicare ID - Type Unspecified