Healthcare Provider Details

I. General information

NPI: 1669157590
Provider Name (Legal Business Name): FIKE FAMILY PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 E MILLTOWN RD STE 105
WOOSTER OH
44691-1276
US

IV. Provider business mailing address

128 E MILLTOWN RD STE 105
WOOSTER OH
44691-1276
US

V. Phone/Fax

Practice location:
  • Phone: 133-034-5806
  • Fax:
Mailing address:
  • Phone: 133-034-5806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHALON J FIKE
Title or Position: OWNER
Credential: MD
Phone: 330-345-8060