MEDICARE: GUILLARD INTERNAL MEDICINE INC.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CF3479	OTHER	PA	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	39D0688402	OTHER	PA	CLIA
4	10085	OTHER	PA	GEISINGER HEALTH PLAN
5	02276900	OTHER	PA	CAIC/CAPITAL BLUE CROSS

NPI Number	:	1033102785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUILLARD INTERNAL MEDICINE INC.

Provider Business Mailing Address
First Line	:	905 UNIVERSITY DR
Second Line	:	SUITE 1
City	:	STATE COLLEGE
State	:	PA
Zip	:	16801-6626
Country	:	US
Telephone Number	:	814-237-3122
Fax Number	:	814-237-4050

Provider Business Practice Location Address
First Line	:	905 UNIVERSITY DR
Second Line	:	SUITE 1
City	:	STATE COLLEGE
State	:	PA
Zip	:	16801-6626
Country	:	US
Telephone Number	:	814-237-3122
Fax Number	:	814-237-4050

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FRANK GUILLARD
Credential	:	M.D.
Telephone Number	:	814-237-3122

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	09/14/2011

2571 LAFEUILLE AVE
CINCINNATI, OH
45211-8200

Practice Phone: 513-836-1000
Practice Fax: 888-527-4411

905 UNIVERSITY DR
STATE COLLEGE, PA
16801-6626