Provider Demographics
NPI:1548521594
Name:GUASCO, JESSE M (DO)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:M
Last Name:GUASCO
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:804 SERVICE RD # A109F
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-2976
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:909 FEE RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824
Practice Address - Country:US
Practice Address - Phone:551-735-3307
Practice Address - Fax:517-432-3603
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2018-07-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101020051204D00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1548521594Medicaid