Provider Demographics
NPI:1932429776
Name:GUAN, STACEY YI (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:YI
Last Name:GUAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 FAIRWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2522
Mailing Address - Country:US
Mailing Address - Phone:614-861-7051
Mailing Address - Fax:614-861-0614
Practice Address - Street 1:1171 FAIRWAY BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2522
Practice Address - Country:US
Practice Address - Phone:614-861-7051
Practice Address - Fax:614-861-0614
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.120145207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0073159Medicaid
OHH133333Medicare PIN