Provider Demographics
NPI:1245239235
Name:GUIDA, STEPHEN V (DPM)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:V
Last Name:GUIDA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 NE 20TH TER STE 209
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4510
Mailing Address - Country:US
Mailing Address - Phone:954-776-1612
Mailing Address - Fax:954-776-1699
Practice Address - Street 1:4800 NE 20TH TER STE 209
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4510
Practice Address - Country:US
Practice Address - Phone:954-776-1612
Practice Address - Fax:954-776-1699
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2047213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
668778920OtherAETNA
FL390124600Medicaid
FL6200453OtherGHI
FL0811110001OtherDMERC
FL650638546OtherTAX ID
332541OtherHUMANA