Provider Demographics
NPI:1730199340
Name:GUILD, GORDON PHIL (DO)
Entity type:Individual
Prefix:MR
First Name:GORDON
Middle Name:PHIL
Last Name:GUILD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 E CUMMINS ST
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286
Mailing Address - Country:US
Mailing Address - Phone:517-423-7458
Mailing Address - Fax:517-423-7939
Practice Address - Street 1:502 E CUMMINS ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286
Practice Address - Country:US
Practice Address - Phone:517-423-7458
Practice Address - Fax:517-423-7939
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006729208D00000X
MI006729207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080D610230OtherBLUE CROSS BLUE SHIELD
MI3216097Medicaid
E33198Medicare UPIN