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29804 Lakeshore Blvd Willowick OH 44095 | |
(440) 833-2095 | |
(440) 833-2096 |
Full Name | |
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Speciality | Family Medicine |
Location | 29804 Lakeshore Blvd, Willowick, 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 |
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Po Box 714328 Columbus OH 43271-4328 Ph: (800) 354-1985 | 29804 Lakeshore Blvd Willowick OH 44095 Ph: (440) 833-2095 |
NPI Number | 1326141987 |
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Provider Enumeration Date | 09/07/2006 |
Last Update Date | 04/08/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1326141987 | NPI | - | NPPES |
2694259 | Medicaid | OH |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
207R00000X | Internal Medicine | 35-084193 (Ohio) | Secondary |
208000000X | Pediatrics | 35-084193 (* (Not Available)) | Secondary |