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General NPI Number Information
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NPI Number | 1053398206
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Entity Type | Organization
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Legal Business Name | STATE ROAD FAMILY PRACTICE INC
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 01/06/2009
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Provider Practice Location Address
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Address Line | 12744 STATE ROAD
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City | NORTH ROYALTON
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State | OH
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Zip | 44133-3910
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Country | US
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Telephone | 440-582-1484
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Fax | 440-582-1594
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Provider Business Mailing Address
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Address Line | 12744 STATE ROAD
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City | NORTH ROYALTON
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State | OH
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Zip | 44133-3910
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Country | US
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Telephone | 440-582-1484
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Fax | 440-582-1594
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MATTHEW JOSEPH FRANTZ
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Credential | DO
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Telephone | 440-582-1484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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