Provider Demographics
NPI:1760456461
Name:GUO, MICHAEL Z (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:Z
Last Name:GUO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2500 NESCONSET HWY BLDG 5B
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2552
Mailing Address - Country:US
Mailing Address - Phone:631-675-9508
Mailing Address - Fax:631-675-9511
Practice Address - Street 1:2500 NESCONSET HWY BLDG 5B
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2552
Practice Address - Country:US
Practice Address - Phone:631-675-9508
Practice Address - Fax:631-675-9511
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2224992084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02196041Medicaid
NYH51973Medicare UPIN
NY388N02Medicare ID - Type Unspecified