Provider Demographics
NPI:1760793574
Name:GUZMAN-ABLOG, MYLEEN TAGUIBAO (MD)
Entity Type:Individual
Prefix:DR
First Name:MYLEEN
Middle Name:TAGUIBAO
Last Name:GUZMAN-ABLOG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MYLEEN
Other - Middle Name:TAGUIBAO
Other - Last Name:GUZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:903 S. ASHLAND AVE.
Mailing Address - Street 2:APARTMENT 102-B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607
Mailing Address - Country:US
Mailing Address - Phone:773-542-2000
Mailing Address - Fax:
Practice Address - Street 1:1500 S. CALIFORNIA AVE
Practice Address - Street 2:MT SINAI HOSPITAL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608
Practice Address - Country:US
Practice Address - Phone:773-542-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036129527208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics