Provider Demographics
NPI:1184652497
Name:TREVINO, GUILLERMO G (MD)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:G
Last Name:TREVINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 MOTE DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45318-1260
Mailing Address - Country:US
Mailing Address - Phone:937-473-3025
Mailing Address - Fax:937-473-3196
Practice Address - Street 1:2600 MOTE DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:OH
Practice Address - Zip Code:45318-1260
Practice Address - Country:US
Practice Address - Phone:937-473-3025
Practice Address - Fax:937-473-3196
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086082207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2603561Medicaid
OHP00356876Medicare ID - Type UnspecifiedRAILROAD MEDICARE
OHTR4197251Medicare ID - Type Unspecified
OH2603561Medicaid
OH2603561Medicaid