Provider Demographics
NPI:1952433963
Name:DE GUZMAN, JOEL IMPERIAL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:IMPERIAL
Last Name:DE GUZMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1117 S VAN DYKE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-8467
Mailing Address - Country:US
Mailing Address - Phone:989-269-7252
Mailing Address - Fax:989-269-7304
Practice Address - Street 1:1117 S VAN DYKE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-8467
Practice Address - Country:US
Practice Address - Phone:989-269-7252
Practice Address - Fax:989-269-7304
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2011-01-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIJD091071208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIJD091071OtherLICENSE
MII73568Medicare UPIN