Individual
MATEO GUANZON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2150 GETTLER ST STE 400, DYER, IN 46311-2385
(219) 865-0893
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4868
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
01035781A
IN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
01035781
IN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
01035781A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100346800
—
IN
05
—
300010982
—
IN
Enumeration date
06/17/2005
Last updated
03/22/2021
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