Healthcare Provider Details

I. General information

NPI: 1811520224
Provider Name (Legal Business Name): WILLOW BROOK CRITICAL CARE MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2020
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 S CENTRAL AVE
GLENDALE CA
91204-2508
US

IV. Provider business mailing address

4535 DRESSLER RD NW
CANTON OH
44718-2545
US

V. Phone/Fax

Practice location:
  • Phone: 448-474-4019
  • Fax: 330-493-8677
Mailing address:
  • Phone: 844-474-4019
  • Fax: 781-276-6486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN PETER MARON
Title or Position: MD
Credential: MD
Phone: 303-493-4443