MEDICARE: NORTH COAST GASTROENTEROLOGY, 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	174400000X	Specialist		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689793655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH COAST GASTROENTEROLOGY, INC

Provider Business Mailing Address
First Line	:	125 E BROAD ST STE 114
Second Line	:
City	:	ELYRIA
State	:	OH
Zip	:	44035-6429
Country	:	US
Telephone Number	:	440-329-5943
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 E BROAD ST STE 114
Second Line	:
City	:	ELYRIA
State	:	OH
Zip	:	44035-6429
Country	:	US
Telephone Number	:	440-329-5943
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES E LISI
Credential	:	M.D.
Telephone Number	:	440-329-5943

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/27/2007

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