Healthcare Provider Details

I. General information

NPI: 1740232735
Provider Name (Legal Business Name): LYNN WOJTASIK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3973 LOOMIS PKWY SUITE B
RAVENNA OH
44266-1803
US

IV. Provider business mailing address

3973 LOOMIS PKWY SUITE B
RAVENNA OH
44266-1803
US

V. Phone/Fax

Practice location:
  • Phone: 330-296-8239
  • Fax: 330-296-6528
Mailing address:
  • Phone: 330-296-8239
  • Fax: 330-296-6528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35077399
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: