Healthcare Provider Details

I. General information

NPI: 1811964380
Provider Name (Legal Business Name): AMY C LAKRITZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4575 STEPHENS CIR NW
CANTON OH
44718-3629
US

IV. Provider business mailing address

4575 STEPHENS CIR NW
CANTON OH
44718-3629
US

V. Phone/Fax

Practice location:
  • Phone: 330-499-9944
  • Fax: 330-499-3056
Mailing address:
  • Phone: 330-499-9944
  • Fax: 330-499-3056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35069524
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: