Healthcare Provider Details

I. General information

NPI: 1962638239
Provider Name (Legal Business Name): JOHN MICHAEL VRACIU D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOHN MICHAEL VRACIU D.O.

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4773 HIGBEE AVE NW
CANTON OH
44718-2551
US

IV. Provider business mailing address

4773 HIGBEE AVE NW
CANTON OH
44718-2551
US

V. Phone/Fax

Practice location:
  • Phone: 330-492-6500
  • Fax: 330-492-6502
Mailing address:
  • Phone: 330-492-6500
  • Fax: 330-492-6502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number34.010320
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number34.010320
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number34.010320
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: