Healthcare Provider Details

I. General information

NPI: 1316325384
Provider Name (Legal Business Name): ASMAU N MISAWA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8423 MARKET ST STE 101
BOARDMAN OH
44512-6778
US

IV. Provider business mailing address

2347 FIFTH AVE
MCKEESPORT PA
15132-1126
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-8700
  • Fax:
Mailing address:
  • Phone: 412-673-5009
  • Fax: 412-673-1021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD468437
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60828363
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.144229
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: