Provider Demographics
NPI:1568867265
Name:LM GUIRNALDA, MD LLC
Entity Type:Organization
Organization Name:LM GUIRNALDA, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUIRNALDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-374-1392
Mailing Address - Street 1:3460 S DIXIE DR
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-2315
Mailing Address - Country:US
Mailing Address - Phone:937-374-1392
Mailing Address - Fax:937-374-1393
Practice Address - Street 1:36 N DETROIT ST
Practice Address - Street 2:SUITE 104
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-2909
Practice Address - Country:US
Practice Address - Phone:937-374-1392
Practice Address - Fax:937-374-1393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.035875261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH407360Medicare PIN