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29804 Lakeshore Blvd Willowick OH 44095-4611 | |
(440) 354-1899 | |
(440) 354-1089 |
Full Name | |
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Speciality | Family Medicine - Sports Medicine |
Location | 29804 Lakeshore Blvd, Willowick, Ohio |
Authorized Official Name and Position | Robert Tracz (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 4403541642 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 714328 Columbus OH 43271-4328 Ph: (800) 354-1985 | 29804 Lakeshore Blvd Willowick OH 44095-4611 Ph: (440) 354-1899 |
NPI Number | 1639315062 |
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Provider Enumeration Date | 01/07/2009 |
Last Update Date | 01/07/2009 |
Identifier | Type | State | Issuer |
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1639315062 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Primary |