Healthcare Provider Details

I. General information

NPI: 1972912665
Provider Name (Legal Business Name): DEREK PUCHTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 N MAIN ST
FINDLAY OH
45840-3818
US

IV. Provider business mailing address

1918 N MAIN ST
FINDLAY OH
45840-3818
US

V. Phone/Fax

Practice location:
  • Phone: 419-425-5050
  • Fax: 419-423-6464
Mailing address:
  • Phone: 419-425-5050
  • Fax: 419-426-6464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: