Organization
GUANCO CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KIRK GUANCO (OFFICE MANAGER)
(586) 566-6880
Entity
Organization
Contact information
Practice address
47100 SCHOENHERR RD, SUITE B, SHELBY TOWNSHIP, MI 48315-4716
(586) 566-6880
(586) 566-6882
Mailing address
47100 SCHOENHERR RD, SUITE B, SHELBY TOWNSHIP, MI 48315-4716
(586) 566-6880
(586) 566-6882
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
4301031105
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2107150
—
MI
Enumeration date
11/27/2007
Last updated
11/27/2007
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