Healthcare Provider Details

I. General information

NPI: 1831607928
Provider Name (Legal Business Name): MATTHEW J DOERSCHUK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9526 FREEMAN RD
LISBON OH
44432-9759
US

IV. Provider business mailing address

9526 FREEMAN RD
LISBON OH
44432-9759
US

V. Phone/Fax

Practice location:
  • Phone: 330-268-7502
  • Fax:
Mailing address:
  • Phone: 330-268-7502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW J DOERSCHUK
Title or Position: OWNER
Credential:
Phone: 330-268-7502