Healthcare Provider Details

I. General information

NPI: 1609088244
Provider Name (Legal Business Name): LOUISE KOLARIK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 7TH ST SW
CANTON OH
44710-1709
US

IV. Provider business mailing address

PO BOX 80690
CANTON OH
44708-0690
US

V. Phone/Fax

Practice location:
  • Phone: 330-363-6242
  • Fax: 330-453-4263
Mailing address:
  • Phone: 330-363-7444
  • Fax: 330-363-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35093099
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: