Provider Demographics
NPI:1689776593
Name:GUINTO, MERT VERZO
Entity Type:Individual
Prefix:DR
First Name:MERT
Middle Name:VERZO
Last Name:GUINTO
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:MAMERTO
Other - Middle Name:VERZO
Other - Last Name:GUINTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2905 WHITETAIL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-3866
Mailing Address - Country:US
Mailing Address - Phone:217-345-4503
Mailing Address - Fax:217-345-4503
Practice Address - Street 1:721 E COURT ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944-2460
Practice Address - Country:US
Practice Address - Phone:217-465-4141
Practice Address - Fax:217-463-2769
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-053711207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD09995Medicare UPIN