Provider Demographics
NPI:1841525086
Name:GEORGE J GUGINO MD PC
Entity type:Organization
Organization Name:GEORGE J GUGINO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GUGINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-868-4197
Mailing Address - Street 1:1941 GATES ST
Mailing Address - Street 2:PO BOX 394
Mailing Address - City:REESE
Mailing Address - State:MI
Mailing Address - Zip Code:48757-9555
Mailing Address - Country:US
Mailing Address - Phone:989-868-4197
Mailing Address - Fax:989-868-3770
Practice Address - Street 1:1941 GATES ST
Practice Address - Street 2:
Practice Address - City:REESE
Practice Address - State:MI
Practice Address - Zip Code:48757-9555
Practice Address - Country:US
Practice Address - Phone:989-868-4197
Practice Address - Fax:989-868-3770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGG024883208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1392012Medicaid
MIB44155Medicare UPIN
MI0793377Medicare PIN