Provider Demographics
NPI:1710084041
Name:GUZMAN-VILLAR, BRENDA M (MD)
Entity Type:Individual
Prefix:MISS
First Name:BRENDA
Middle Name:M
Last Name:GUZMAN-VILLAR
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Gender:F
Credentials:MD
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Mailing Address - Street 1:401 NORTH MICHIGAN AVE
Mailing Address - Street 2:1200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4264
Mailing Address - Country:US
Mailing Address - Phone:312-635-0973
Mailing Address - Fax:813-290-9691
Practice Address - Street 1:1919 LAKELAND HILLS BLVD
Practice Address - Street 2:PALM TERRACE OF LAKELAND
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-2901
Practice Address - Country:US
Practice Address - Phone:863-688-5612
Practice Address - Fax:863-687-8870
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME119566208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01393385OtherRAILROAD MEDICARE
FL013483900Medicaid
FLME119566OtherLICENSE
FLP01393385OtherRAILROAD MEDICARE