Provider Demographics
NPI:1801805122
Name:AUDET, GUY (MD)
Entity type:Individual
Prefix:
First Name:GUY
Middle Name:
Last Name:AUDET
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 1977
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62705-1977
Mailing Address - Country:US
Mailing Address - Phone:217-544-6464
Mailing Address - Fax:217-757-6021
Practice Address - Street 1:1600 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-1136
Practice Address - Country:US
Practice Address - Phone:217-243-5584
Practice Address - Fax:217-243-5877
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL035099OtherHEALTH ALLIANCE
IL06922921OtherBC/BS
IL49743OtherGROUP HEALTH
IL273716OtherHEALTHLINK
IL273716OtherHEALTHLINK
IL49743OtherGROUP HEALTH