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9485 Mentor Ave #210 Mentor OH 44060-4597 | |
| (440) 205-5745 | |
| (440) 205-5735 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 9485 Mentor Ave, Mentor, Ohio |
| Authorized Official Name and Position | Robert Tracz (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 4403541051 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 714328 Columbus OH 43271-4328 Ph: (800) 354-1985 | 9485 Mentor Ave #210 Mentor OH 44060-4597 Ph: (440) 205-5745 |
| NPI Number | 1861420804 |
|---|---|
| Provider Enumeration Date | 06/29/2006 |
| Last Update Date | 09/06/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861420804 | NPI | - | NPPES |
| 2183499 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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Lake County Family Practice, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 9500 Mentor Avenue, Suite 100, Mentor, OH 44060 Phone: 440-352-4880 Fax: 440-352-3629 | |
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Bowersox Wound Care Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6966 Heisley Rd Ste F, Mentor, OH 44060 Phone: 440-488-4575 | |
Wound Think Consulting, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5452 Grace Dr, Mentor, OH 44060 Phone: 440-227-2000 | |
Suhas Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 9110 Mentor Ave Ste 9b, Mentor, OH 44060 Phone: 440-701-8030 |