MEDICARE: GUILLERMO G TREVINO MD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35086082	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184652497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUILLERMO G TREVINO MD

Provider Business Mailing Address
First Line	:	2600 MOTE DR
Second Line	:
City	:	COVINGTON
State	:	OH
Zip	:	45318-1260
Country	:	US
Telephone Number	:	937-473-3025
Fax Number	:	937-473-3196

Provider Business Practice Location Address
First Line	:	2600 MOTE DR
Second Line	:
City	:	COVINGTON
State	:	OH
Zip	:	45318-1260
Country	:	US
Telephone Number	:	937-473-3025
Fax Number	:	937-473-3196

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	06/23/2014

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