Healthcare Provider Details

I. General information

NPI: 1295915569
Provider Name (Legal Business Name): NORTHERN OHIO ARTHRITIS CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36855 AMERICAN WAY STE A
AVON OH
44011-4054
US

IV. Provider business mailing address

36855 AMERICAN WAY STE A
AVON OH
44011-4054
US

V. Phone/Fax

Practice location:
  • Phone: 440-934-2200
  • Fax: 440-934-2213
Mailing address:
  • Phone: 440-934-2200
  • Fax: 440-934-2213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number35054958
License Number StateOH

VIII. Authorized Official

Name: DR. ROBERT STEPHEN PERHALA
Title or Position: PHYSICIAN
Credential: MD
Phone: 440-934-2200