Healthcare Provider Details

I. General information

NPI: 1003841669
Provider Name (Legal Business Name): DIABETES & ENDOCRINOLOGY ASSOCIATES OF STARK COUNTY INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4565 DRESSLER RD NW SUITE #111
CANTON OH
44718-2579
US

IV. Provider business mailing address

4565 DRESSLER RD NW SUITE #111
CANTON OH
44718-2579
US

V. Phone/Fax

Practice location:
  • Phone: 330-493-0013
  • Fax: 330-493-6973
Mailing address:
  • Phone: 330-493-0013
  • Fax: 330-493-6973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: ARVIND Y KRISHNA
Title or Position: OWNER
Credential: M.D.
Phone: 330-493-0013