Healthcare Provider Details

I. General information

NPI: 1417038134
Provider Name (Legal Business Name): CHILDREN'S PHYSICIANS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4575 EVERHARD RD NW
CANTON OH
44718-2406
US

IV. Provider business mailing address

4575 EVERHARD RD NW
CANTON OH
44718-2406
US

V. Phone/Fax

Practice location:
  • Phone: 330-494-1426
  • Fax: 330-966-1644
Mailing address:
  • Phone: 330-494-1426
  • Fax: 330-966-1644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: MS. KAREN M CASSLER
Title or Position: OFFICE MANAGER
Credential:
Phone: 330-494-1426