Healthcare Provider Details

I. General information

NPI: 1982656633
Provider Name (Legal Business Name): ROBERT MARK FUMICH, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6803 MAYFIELD RD SUITE 314
MAYFIELD HTS OH
44124-2271
US

IV. Provider business mailing address

6803 MAYFIELD RD SUITE 314
MAYFIELD HTS OH
44124-2271
US

V. Phone/Fax

Practice location:
  • Phone: 440-460-0454
  • Fax: 440-460-0492
Mailing address:
  • Phone: 440-460-0454
  • Fax: 440-460-0492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35-03-8194
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number35-03-8194
License Number StateOH

VIII. Authorized Official

Name: DR. ROBERT MARK FUMICH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 440-460-0454