Healthcare Provider Details

I. General information

NPI: 1902856487
Provider Name (Legal Business Name): UNION INTERNAL MEDICINE SPECIALTIES LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 UNION AVE SUITE 187
DOVER OH
44622-3004
US

IV. Provider business mailing address

515 UNION AVE SUITE 187
DOVER OH
44622-3004
US

V. Phone/Fax

Practice location:
  • Phone: 330-343-4411
  • Fax: 330-336-4111
Mailing address:
  • Phone: 330-343-4411
  • Fax: 330-336-4111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JEAN ANN PADRO
Title or Position: ASSISTANT PRACTICE MANAGER
Credential:
Phone: 330-364-5559