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NPI Code Detail

MEDICARE: GREAT HEALTH MEDICAL OH INC

MEDICARE: GREAT HEALTH MEDICAL OH 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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1104630912
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREAT HEALTH MEDICAL OH INC
Provider Business Mailing Address
First Line : 407 WILLOUGHBY AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11205-4590
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1552 N HONEYTOWN RD
Second Line :
City : WOOSTER
State : OH
Zip : 44691-9511
Country : US
Telephone Number : 718-470-0288
Fax Number :
Authorized Official
Title or Position : OWNER
Name : AZLAN TARIQ
Credential :
Telephone Number : 312-709-7238
Provider Enumeration Date : 02/03/2025
Last Update Date : 12/10/2025

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Directions to “GREAT HEALTH MEDICAL OH INC ” Practice Location

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