Provider Demographics
NPI:1649263120
Name:GUO, JINGTAO J (MD)
Entity type:Individual
Prefix:DR
First Name:JINGTAO
Middle Name:J
Last Name:GUO
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 1:2252 S CANAL ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1838
Mailing Address - Country:US
Mailing Address - Phone:312-225-5829
Mailing Address - Fax:
Practice Address - Street 1:2252 S CANAL ST STE 201
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1838
Practice Address - Country:US
Practice Address - Phone:312-225-5829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-107010207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-107010-2Medicaid
ILK13851/357801Medicare ID - Type Unspecified
IL036-107010-2Medicaid
ILH86197Medicare UPIN