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9500 Mentor Ave Suite 100 Mentor OH 44060-8713 | |
| (440) 352-4880 | |
| (440) 352-3629 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 9500 Mentor Ave, Mentor, Ohio |
| Authorized Official Name and Position | Robert B Tracz (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 4403541642 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 715165 Columbus OH 43271-0001 Ph: (440) 352-4880 | 9500 Mentor Ave Suite 100 Mentor OH 44060-8713 Ph: (440) 352-4880 |
| NPI Number | 1821253048 |
|---|---|
| Provider Enumeration Date | 07/28/2008 |
| Last Update Date | 07/28/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821253048 | NPI | - | NPPES |
| LA9368241 | Other | OH | MEDICARE GROUP NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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