Individual
GREGORY V GUARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2200 E WASHINGTON ST, BLOOMINGTON, IL 61701-4364
(309) 665-5925
Mailing address
2538 MOMENTUM PL, CHICAGO, IL 60689-0001
(616) 975-1845
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036071753
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00645055
RAILROAD MEDICARE
IL
Enumeration date
05/02/2006
Last updated
07/06/2009
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