Kenneth John Guidera, M.D.

Primary specialty

Pediatric Orthopaedic Surgery PhysicianTaxonomy code 207XP3100X

License

47329 Issued in MN

Practice address

2025 E River Pkwy
Minneapolis, MN 55414-3604

Phone

(612) 596-6187

Fax

(612) 339-7634

NPI assigned

Jan 16, 2007

Last updated

Apr 4, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• C3 Wellness, LLC

  dba C3 Wellness Spa

  • Multi-Specialty Clinic/Center
  • Kissimmee, FL
  • NPI 1811490287
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301875200000",
    "number": "1922150697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 209036",
            "address_2": "SHRINERS HOSPITALS FOR CHILDREN TWIN CITIES",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753209036",
            "telephone_number": "813-281-8478",
            "fax_number": "813-281-8113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2025 E RIVER PKWY",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554143604",
            "telephone_number": "612-596-6187",
            "fax_number": "612-339-7634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUIDERA",
        "first_name": "KENNETH",
        "middle_name": "JOHN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2011-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XP3100X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Pediatric Orthopaedic Surgery",
            "state": "MN",
            "license": "47329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sixto Guiang III, M.D.
• Guidance Center LLC
• Guidance Home Care Inc.
• Guidance Home Health Care LLC
• Guided Pathway
• Guiding Lights Service LLC
• Claire Lee Guidinger, PH.D.
• Daniel James Guillaume, MD
• Mary Kathleen Guillen
• Sarah Abbott Guillet, L.P.

• Pediatric Orthopaedic Surgery Physician in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Pediatric Orthopaedic Surgery Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.