Basic Information
| Provider Information | |||||||||
| NPI: | 1982721684 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUASTELLO | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1130 W 4TH ST | ||||||||
| Address2: | SUITE 2050 | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660441328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858413636 | ||||||||
| FaxNumber: | 7855055210 | ||||||||
| Practice Location | |||||||||
| Address1: | 1130 W 4TH ST | ||||||||
| Address2: | SUITE 2050 | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660441328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858413636 | ||||||||
| FaxNumber: | 7855055210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 12/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0436590 | KS | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 4301087866 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | 4301087866 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RC0000X | 0436590 | KS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.