Healthcare Provider Details

I. General information

NPI: 1689220352
Provider Name (Legal Business Name): HILL CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2019
Last Update Date: 08/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 HILL AVE
TOLEDO OH
43615-5410
US

IV. Provider business mailing address

4425 HILL AVE
TOLEDO OH
43615-5410
US

V. Phone/Fax

Practice location:
  • Phone: 567-318-5440
  • Fax: 567-318-5472
Mailing address:
  • Phone: 567-318-5440
  • Fax: 567-318-5472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTIAN MADUOMA
Title or Position: CEO
Credential: MD
Phone: 419-378-1422