| Dr Bereket A Guangul | |
|
18701 N 67th Ave Glendale AZ 85308-7100 | |
| (623) 561-1000 | |
| Not Available |
| Full Name | Dr Bereket A Guangul |
|---|---|
| Speciality | Internal Medicine |
| Location | 18701 N 67th Ave, Glendale, Arizona |
| Authorized Official Name and Position | Bereket A Guangul (SOLE MEMBER) |
| Authorized Official Contact | 4802283133 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Bereket A Guangul 19801 N 59th Ave #11073 Glendale AZ 85318 Ph: (480) 228-3133 | Dr Bereket A Guangul 18701 N 67th Ave Glendale AZ 85308-7100 Ph: (623) 561-1000 |
| NPI Number | 1871848341 |
|---|---|
| Provider Enumeration Date | 07/19/2012 |
| Last Update Date | 07/14/2022 |
| Medicare PECOS PAC ID | 2062891070 |
|---|---|
| Medicare Enrollment ID | O20220622002274 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871848341 | NPI | - | NPPES |
| 605956 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 43772 (Arizona) | Secondary |
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| Provider Name | Bereket A Guangul |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700190964 PECOS PAC ID: 8820272792 Enrollment ID: I20110418000828 |
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