Healthcare Provider Details

I. General information

NPI: 1598714388
Provider Name (Legal Business Name): ANTHONY E BACEVICE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1997 HEALTHWAY DR SUITE 203
AVON OH
44011-2834
US

IV. Provider business mailing address

24701 EUCLID AVE THIRD FLOOR BILLING SERVICES
EUCLID OH
44117-1714
US

V. Phone/Fax

Practice location:
  • Phone: 440-988-6884
  • Fax: 440-988-6896
Mailing address:
  • Phone: 440-988-6884
  • Fax: 440-988-6896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35047772
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: