Healthcare Provider Details

I. General information

NPI: 1134216005
Provider Name (Legal Business Name): MICHAEL IVAN MEDGYESSY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4028 BROADVIEW RD #2
RICHFIELD OH
44286-9230
US

IV. Provider business mailing address

4028 BROADVIEW RD #2
RICHFIELD OH
44286-9230
US

V. Phone/Fax

Practice location:
  • Phone: 440-213-8695
  • Fax:
Mailing address:
  • Phone: 440-213-8695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1365
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: