Provider Demographics
NPI:1427258946
Name:GUIDO CUADRA, LEONEL (MD)
Entity type:Individual
Prefix:
First Name:LEONEL
Middle Name:
Last Name:GUIDO CUADRA
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 1:1200 BRECKENRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1089
Mailing Address - Country:US
Mailing Address - Phone:270-684-0028
Mailing Address - Fax:270-685-8233
Practice Address - Street 1:1200 BRECKENRIDGE STREET
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1090
Practice Address - Country:US
Practice Address - Phone:270-685-8224
Practice Address - Fax:270-685-8228
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24249207R00000X
KY43942207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100153660Medicaid
KYP400032936Medicare PIN
KYP400032936Medicare PIN