Healthcare Provider Details

I. General information

NPI: 1902932353
Provider Name (Legal Business Name): DIGESTIVE WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 SOUTH CLEVELAND-MASSILLON ROAD
NORTON OH
44203
US

IV. Provider business mailing address

3939 CLEVELAND MASSILLON RD
NORTON OH
44203-5611
US

V. Phone/Fax

Practice location:
  • Phone: 330-237-1058
  • Fax: 330-237-1059
Mailing address:
  • Phone: 330-237-1058
  • Fax: 330-237-1059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GHULAM N. MIR
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 330-753-6643