Healthcare Provider Details

I. General information

NPI: 1982685558
Provider Name (Legal Business Name): MANUEL MICHAEL SPIRTOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9471 MARKET ST STE A
NORTH LIMA OH
44452
US

IV. Provider business mailing address

9471 MARKET ST STE B
NORTH LIMA OH
44452-8702
US

V. Phone/Fax

Practice location:
  • Phone: 330-726-7100
  • Fax: 330-758-0347
Mailing address:
  • Phone: 330-729-2388
  • Fax: 330-629-6568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-05-6709
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: