Provider Demographics
NPI:1265409429
Name:POWER, GUY C (MD)
Entity type:Individual
Prefix:
First Name:GUY
Middle Name:C
Last Name:POWER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1847
Mailing Address - Country:US
Mailing Address - Phone:231-727-5211
Mailing Address - Fax:231-727-4571
Practice Address - Street 1:215 E MANSION ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068
Practice Address - Country:US
Practice Address - Phone:269-789-0025
Practice Address - Fax:269-789-0445
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057496207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4555891Medicaid
MIE88309Medicare UPIN
MI4555891Medicaid
MION82400Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER