Provider Demographics
NPI:1639199631
Name:AMURAO, GUILLERMO V (MD)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:V
Last Name:AMURAO
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 1:700 N COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:OH
Mailing Address - Zip Code:44827-1455
Mailing Address - Country:US
Mailing Address - Phone:419-468-0522
Mailing Address - Fax:
Practice Address - Street 1:269 PORTLAND WAY S
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-2312
Practice Address - Country:US
Practice Address - Phone:419-462-4588
Practice Address - Fax:419-462-4589
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016039207R00000X
GA059744207RC0200X, 207RP1001X
OH35.079986207RC0200X, 208M00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2380856Medicaid
GA412857445BMedicaid
GA52220608001OtherBCBS OF GEORGIA
GA412857445AMedicaid
GA7404427OtherAETNA
GA29BDCQWMedicare PIN
GA202I29345Medicare PIN
H65427Medicare UPIN
SCG59744Medicaid