| Wauseon Family Practice | |
|
725 S Shoop Ave Wauseon OH 43567-1702 | |
| (419) 337-9990 | |
| (419) 337-9996 |
| Full Name | Wauseon Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 725 S Shoop Ave, Wauseon, Ohio |
| Authorized Official Name and Position | Ramon Anthony Issa (OWNER) |
| Authorized Official Contact | 4193379990 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wauseon Family Practice 725 S Shoop Ave Wauseon OH 43567-1702 Ph: (419) 337-9990 | Wauseon Family Practice 725 S Shoop Ave Wauseon OH 43567-1702 Ph: (419) 337-9990 |
| NPI Number | 1285815076 |
|---|---|
| Provider Enumeration Date | 11/20/2007 |
| Last Update Date | 04/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285815076 | NPI | - | NPPES |
| 2504669 | Medicaid | OH | |
| 000000350389 | Other | ANTHEM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 35083971 (Ohio) | Primary |
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