Healthcare Provider Details

I. General information

NPI: 1659193746
Provider Name (Legal Business Name): ALMADELIC MEDICAL GROUP OHA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 MARKET AVE N STE 100
CANTON OH
44721-2430
US

IV. Provider business mailing address

1385 S COLORADO BLVD # A712
DENVER CO
80222-3304
US

V. Phone/Fax

Practice location:
  • Phone: 303-521-0533
  • Fax:
Mailing address:
  • Phone: 303-521-0533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: KIRILL MERKULOV
Title or Position: CFO
Credential:
Phone: 303-521-0533