MEDICARE: LIONEL GUILLAUME M.D.

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	2084P0800X	Psychiatry Physician	017032	LA
2	174400000X	Specialist	017032	LA

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	:	1619946001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIONEL GUILLAUME M.D.

Provider Business Mailing Address
First Line	:	3018 OLD MINDEN RD
Second Line	:	SUITE 1212
City	:	BOSSIER CITY
State	:	LA
Zip	:	71112-2476
Country	:	US
Telephone Number	:	318-747-1665
Fax Number	:	318-747-1597

Provider Business Practice Location Address
First Line	:	3018 OLD MINDEN RD
Second Line	:	SUITE 1212
City	:	BOSSIER CITY
State	:	LA
Zip	:	71112-2495
Country	:	US
Telephone Number	:	318-747-1665
Fax Number	:	318-747-1597

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	09/17/2021

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