Provider Demographics
NPI:1780892521
Name:GU, ALEX
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:GU
Suffix:
Gender:M
Credentials:
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 309
Mailing Address - Street 2:
Mailing Address - City:MONEE
Mailing Address - State:IL
Mailing Address - Zip Code:60449-0309
Mailing Address - Country:US
Mailing Address - Phone:708-534-2168
Mailing Address - Fax:708-328-3668
Practice Address - Street 1:1655 GREAT PLAINS DR
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-3283
Practice Address - Country:US
Practice Address - Phone:708-534-2168
Practice Address - Fax:708-328-3668
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2013-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000029246ZC0007X
246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant