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Individual

GUY V JEANBLANC

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
3409 LUDINGTON ST, SUITE 206, ESCANABA, MI 49829-4212
(906) 786-5562
Mailing address
3409 LUDINGTON ST, SUITE 206, ESCANABA, MI 49829-4212
(906) 786-5562

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4301082854
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0202110321
BLUE CROSS BLUE SHIELD MI
MI
05
4886348
MI
01
DE8529
RAILROAD MEDICARE
GA
01
P00320324
RAILROAD MEDICARE
GA
Enumeration date
05/21/2006
Last updated
12/10/2007
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