Provider Demographics
NPI:1881875763
Name:JAMES A GUIGELAAR MD PC
Entity type:Organization
Organization Name:JAMES A GUIGELAAR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUIGELAAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-893-9705
Mailing Address - Street 1:200 S WENONA ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-8820
Mailing Address - Country:US
Mailing Address - Phone:989-893-9705
Mailing Address - Fax:989-893-8206
Practice Address - Street 1:200 S WENONA ST
Practice Address - Street 2:SUITE 225
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-8820
Practice Address - Country:US
Practice Address - Phone:989-893-9705
Practice Address - Fax:989-893-8206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJG042006207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1100910252OtherBCBS OF MI
MI4159093Medicaid
MI4159093Medicaid
MIOM90810Medicare PIN