Healthcare Provider Details

I. General information

NPI: 1588072854
Provider Name (Legal Business Name): KEY CLINICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 04/19/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 PORTLAND WAY N LBBY NORTH LOBBY
GALION OH
44833-2312
US

IV. Provider business mailing address

1284 SOM CENTER ROAD STE 368
MAYFIELD HEIGHTS OH
44124-2048
US

V. Phone/Fax

Practice location:
  • Phone: 419-775-9269
  • Fax: 216-916-7779
Mailing address:
  • Phone: 419-775-9269
  • Fax: 216-916-7779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOEL D SIEGAL
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 419-775-9269