Provider Demographics
NPI:1841458015
Name:RAUL GUERRERO, M.D., P.C.
Entity type:Organization
Organization Name:RAUL GUERRERO, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-885-0052
Mailing Address - Street 1:131 KERCHEVAL AVE
Mailing Address - Street 2:SUITE 390
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-3629
Mailing Address - Country:US
Mailing Address - Phone:313-885-0052
Mailing Address - Fax:313-885-6807
Practice Address - Street 1:131 KERCHEVAL AVE
Practice Address - Street 2:SUITE 390
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48236-3629
Practice Address - Country:US
Practice Address - Phone:313-885-0052
Practice Address - Fax:313-885-6807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010357472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI286812Medicaid
E26588OtherUPIN#
1861412033OtherINDIVIDUAL NPI#
MI824831Medicare PIN