Healthcare Provider Details

I. General information

NPI: 1457336562
Provider Name (Legal Business Name): JOHN MILAN URBANCIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13221 RAVENNA RD SUITE 8
CHARDON OH
44024-9047
US

IV. Provider business mailing address

13221 RAVENNA RD SUITE 8
CHARDON OH
44024-9047
US

V. Phone/Fax

Practice location:
  • Phone: 440-286-6155
  • Fax: 440-286-6156
Mailing address:
  • Phone: 440-286-6155
  • Fax: 440-286-6156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35071426
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: