Healthcare Provider Details

I. General information

NPI: 1417992710
Provider Name (Legal Business Name): M E D F PHYSICIANS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 W MAIN ST
COLDWATER OH
45828-1657
US

IV. Provider business mailing address

800 W MAIN ST
COLDWATER OH
45828-1613
US

V. Phone/Fax

Practice location:
  • Phone: 567-890-7185
  • Fax: 419-586-0812
Mailing address:
  • Phone: 419-678-2341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA KLENKE
Title or Position: CEO
Credential:
Phone: 419-678-5117