Healthcare Provider Details

I. General information

NPI: 1275964348
Provider Name (Legal Business Name): POEL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2013
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 S HIGH ST
COLUMBUS OH
43207-1045
US

IV. Provider business mailing address

30701 LORAIN RD STE A
NORTH OLMSTED OH
44070-6325
US

V. Phone/Fax

Practice location:
  • Phone: 440-274-5000
  • Fax: 440-716-8608
Mailing address:
  • Phone: 440-274-5000
  • Fax: 440-716-8608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number34003736
License Number StateOH

VIII. Authorized Official

Name: ROGER GARCIA
Title or Position: PRESIDENT
Credential: D.O.
Phone: 440-274-5000