Healthcare Provider Details

I. General information

NPI: 1831369958
Provider Name (Legal Business Name): MICHAEL HUNYADI LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 MARKET AVE. N.
CANTON OH
44702-1017
US

IV. Provider business mailing address

624 MARKET AVE. N
CANTON OH
44702-1017
US

V. Phone/Fax

Practice location:
  • Phone: 330-493-4553
  • Fax: 330-493-3761
Mailing address:
  • Phone: 330-493-4553
  • Fax: 330-493-3761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0001196
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: