Provider Demographics
NPI:1689613416
Name:SAINT-PHARD, GUERCY (DPM)
Entity Type:Individual
Prefix:DR
First Name:GUERCY
Middle Name:
Last Name:SAINT-PHARD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 MAPLEWOOD CT. #F64
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1381
Mailing Address - Country:US
Mailing Address - Phone:269-471-6835
Mailing Address - Fax:269-926-8528
Practice Address - Street 1:190 W EMPIRE AVE
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-7422
Practice Address - Country:US
Practice Address - Phone:269-926-8535
Practice Address - Fax:269-926-8528
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002223213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480F37288OtherBCBSMI PIN
MI4858290Medicaid
MI4995496Medicaid
MI480006536OtherRAILROAD MEDICARE
MI0N35420005Medicare PIN