Individual
JAN MAGNO DE GUZMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10215 AUBURN PARK DR, FORT WAYNE, IN 46825-2387
(260) 234-5400
(260) 234-5110
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
01083919A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11019468A
STATE LICENSE
IN
Enumeration date
06/18/2017
Last updated
12/15/2021
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