MEDICARE: FAMILY MEDICINE 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	35072373	OH

General Provider Information

NPI Number	:	1841489861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICINE INC

Provider Business Mailing Address
First Line	:	6525 MARKET AVE N
Second Line	:	SUITE 101
City	:	CANTON
State	:	OH
Zip	:	44721-2430
Country	:	US
Telephone Number	:	330-494-9785
Fax Number	:	330-494-9798

Provider Business Practice Location Address
First Line	:	6525 MARKET AVE N
Second Line	:	SUITE 101
City	:	CANTON
State	:	OH
Zip	:	44721-2430
Country	:	US
Telephone Number	:	330-494-9785
Fax Number	:	330-494-9798

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MELANIE ETHELL MIRANDE
Credential	:	M.D.
Telephone Number	:	330-494-9785

Provider Enumeration Date	:	10/16/2007
Last Update Date	:	01/18/2011

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Directions to “FAMILY MEDICINE INC ” Practice Location

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