Provider Demographics
NPI:1689840092
Name:LEVI L. GUERRERO, MD, PC
Entity Type:Organization
Organization Name:LEVI L. GUERRERO, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEVI
Authorized Official - Middle Name:LLUCH
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-376-3100
Mailing Address - Street 1:3532 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DECKERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48427-9615
Mailing Address - Country:US
Mailing Address - Phone:810-376-3100
Mailing Address - Fax:
Practice Address - Street 1:3532 MAIN ST
Practice Address - Street 2:
Practice Address - City:DECKERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48427-9615
Practice Address - Country:US
Practice Address - Phone:810-376-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILG038491208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3365954Medicaid
MIB44620Medicare UPIN
MI3365954Medicaid