Healthcare Provider Details

I. General information

NPI: 1891049862
Provider Name (Legal Business Name): MICHELLE KAPON MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 FAIRLAWN AVE
YOUNGSTOWN OH
44505-2143
US

IV. Provider business mailing address

20 FAIRLAWN AVE
YOUNGSTOWN OH
44505-2143
US

V. Phone/Fax

Practice location:
  • Phone: 330-759-6000
  • Fax: 330-759-6006
Mailing address:
  • Phone: 330-759-6000
  • Fax: 330-759-6006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35093877
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35093877
License Number StateOH

VIII. Authorized Official

Name: MICHELLE KAPON
Title or Position: OWNER
Credential: MD
Phone: 330-759-6000