1659452498 NPI number — LEONARDO GUIRNALDA MD

Table of content: LEONARDO GUIRNALDA MD (NPI 1659452498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659452498 NPI number — LEONARDO GUIRNALDA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUIRNALDA
Provider First Name:
LEONARDO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659452498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1239
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48099-1239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-824-6600
Provider Business Mailing Address Fax Number:
248-324-1477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3033 KETTERING BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MORAINE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45439-1962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-293-2133
Provider Business Practice Location Address Fax Number:
937-293-2161
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  35035875 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000389159 . This is a "ANTHEM BCBS OF OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00300630 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0228300 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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