Healthcare Provider Details

I. General information

NPI: 1235131913
Provider Name (Legal Business Name): SERGUL A ERZURUM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 W WESTERN RESERVE RD
POLAND OH
44514-3541
US

IV. Provider business mailing address

10 DUTTON DR
YOUNGSTOWN OH
44502-1818
US

V. Phone/Fax

Practice location:
  • Phone: 330-746-7691
  • Fax:
Mailing address:
  • Phone: 330-746-7691
  • Fax: 330-743-8368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License NumberOH35-058517E
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35-058517
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: