Provider Demographics
NPI:1659452498
Name:GUIRNALDA, LEONARDO (MD)
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:
Last Name:GUIRNALDA
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:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:248-824-6600
Mailing Address - Fax:248-324-1477
Practice Address - Street 1:3033 KETTERING BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-1962
Practice Address - Country:US
Practice Address - Phone:937-293-2133
Practice Address - Fax:937-293-2161
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35035875207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000389159OtherANTHEM BCBS OF OHIO
OHP00300630OtherRR MEDICARE
OH0228300Medicaid
OHP00300630OtherRR MEDICARE
OH0228300Medicaid
OHA74437Medicare UPIN