Healthcare Provider Details

I. General information

NPI: 1144201294
Provider Name (Legal Business Name): PULMONARY AND CRITICAL SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 HOLLAND RD SUITE 200
MAUMEE OH
43537
US

IV. Provider business mailing address

1661 HOLLAND RD SUITE 200
MAUMEE OH
43537-4207
US

V. Phone/Fax

Practice location:
  • Phone: 419-843-7800
  • Fax: 419-843-3444
Mailing address:
  • Phone: 419-843-7800
  • Fax: 419-843-3444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HANY JOSEPH JACOB
Title or Position: PRES CEO
Credential: M.D.
Phone: 419-843-7800