Healthcare Provider Details

I. General information

NPI: 1235093667
Provider Name (Legal Business Name): DENNIS M MARUSIC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7164 N EXCALIBER DR
CONCORD TOWNSHIP OH
44077-9537
US

IV. Provider business mailing address

7164 N EXCALIBER DR
CONCORD TOWNSHIP OH
44077-9537
US

V. Phone/Fax

Practice location:
  • Phone: 440-537-3219
  • Fax:
Mailing address:
  • Phone: 440-537-3219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN.366225
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: