Provider Demographics
NPI:1952504763
Name:GUILONARD, KRISTIN W (DO)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:W
Last Name:GUILONARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:A
Other - Last Name:WENNERSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1205 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-3409
Mailing Address - Country:US
Mailing Address - Phone:440-240-1655
Mailing Address - Fax:440-233-0194
Practice Address - Street 1:105 LOUDEN CT
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-8027
Practice Address - Country:US
Practice Address - Phone:440-240-1655
Practice Address - Fax:440-240-1663
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005415208000000X
OH34.011067208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0093967Medicaid
OH34.011067OtherOHIO LICENSE