Provider Demographics
NPI:1821026659
Name:GUICHARD, DAREK L (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAREK
Middle Name:L
Last Name:GUICHARD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ASPHODEL DR
Mailing Address - Street 2:
Mailing Address - City:DESTREHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70047-2107
Mailing Address - Country:US
Mailing Address - Phone:985-307-0981
Mailing Address - Fax:
Practice Address - Street 1:179 BELLE TERRE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3347
Practice Address - Country:US
Practice Address - Phone:985-651-6096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD091R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5N000Medicare ID - Type Unspecified
LAT92316Medicare UPIN