Provider Demographics
NPI:1649365537
Name:GUILLAUME, CAROLE A (MD, FAASM)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:A
Last Name:GUILLAUME
Suffix:
Gender:F
Credentials:MD, FAASM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15621 W 87TH STREET PKWY STE 221
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1435
Mailing Address - Country:US
Mailing Address - Phone:913-777-0077
Mailing Address - Fax:877-796-6309
Practice Address - Street 1:8625 COLLEGE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1835
Practice Address - Country:US
Practice Address - Phone:913-777-0077
Practice Address - Fax:877-796-6309
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-28951207Q00000X
KS0428951207QS1201X
MO104177207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G33373Medicare UPIN