Healthcare Provider Details

I. General information

NPI: 1922919042
Provider Name (Legal Business Name): MICHAEL A FERRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 WOODSIDE DR
KENT OH
44240-2663
US

IV. Provider business mailing address

623 WOODSIDE DR
KENT OH
44240-2663
US

V. Phone/Fax

Practice location:
  • Phone: 330-235-2764
  • Fax:
Mailing address:
  • Phone: 330-235-2764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberRJ710081
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: