Provider Demographics
NPI:1962684993
Name:BLANCO-GUZMAN, MERILDA ONYFEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MERILDA
Middle Name:ONYFEL
Last Name:BLANCO-GUZMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6356
Mailing Address - Country:US
Mailing Address - Phone:502-272-5754
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:234 E GRAY ST STE 768
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1901
Practice Address - Country:US
Practice Address - Phone:502-394-6470
Practice Address - Fax:502-394-6477
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014012979207RI0200X
KY52980207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILENROLLEDMedicaid