| |
701 N Lake St Ste 102 Madison OH 44057-3152 | |
(440) 428-1106 | |
(440) 428-8697 |
Full Name | |
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Speciality | Internal Medicine |
Location | 701 N Lake St Ste 102, Madison, Ohio |
Authorized Official Name and Position | Steve Riddle (DIRECTOR OF BILLING SERVICES) |
Authorized Official Contact | 2163836480 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 8792 Belfast ME 04915-8792 Ph: (440) 428-1106 | 701 N Lake St Ste 102 Madison OH 44057-3152 Ph: (440) 428-1106 |
NPI Number | 1578689980 |
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Provider Enumeration Date | 03/21/2007 |
Last Update Date | 04/12/2010 |
Identifier | Type | State | Issuer |
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1578689980 | NPI | - | NPPES |
2129299 | Medicaid | OH |
Taxonomy | Type | License (State) | Status |
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207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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