MEDICARE: STATE ROAD FAMILY PRACTICE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1053398206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATE ROAD FAMILY PRACTICE INC

Provider Business Mailing Address
First Line	:	12744 STATE ROAD
Second Line	:
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-3910
Country	:	US
Telephone Number	:	440-582-1484
Fax Number	:	440-582-1594

Provider Business Practice Location Address
First Line	:	12744 STATE ROAD
Second Line	:
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-3910
Country	:	US
Telephone Number	:	440-582-1484
Fax Number	:	440-582-1594

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MATTHEW JOSEPH FRANTZ
Credential	:	DO
Telephone Number	:	440-582-1484

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	01/06/2009

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Directions to “STATE ROAD FAMILY PRACTICE INC ” Practice Location

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