Healthcare Provider Details

I. General information

NPI: 1720145899
Provider Name (Legal Business Name): COMPREHENSIVE FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4805 SUDER AVE SUITE A
TOLEDO OH
43611-1800
US

IV. Provider business mailing address

4805 SUDER AVE SUITE A
TOLEDO OH
43611-1800
US

V. Phone/Fax

Practice location:
  • Phone: 419-726-1585
  • Fax: 419-726-0381
Mailing address:
  • Phone: 419-726-1585
  • Fax: 419-726-0381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34006654
License Number StateOH

VIII. Authorized Official

Name: DR. MICHAEL PRANAS NEVERAUSKAS
Title or Position: VICE PRESIDENT AND SECRETARY
Credential: D.O
Phone: 419-726-1585