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General NPI Number Information
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NPI Number | 1104971290
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Entity Type | Organization
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Legal Business Name | SYLVAN OAK FAMILY PHYSICIANS LLC
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 02/06/2009
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Provider Practice Location Address
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Address Line | 6800 W CENTRAL AVE UNIT K
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City | TOLEDO
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State | OH
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Zip | 43617-1135
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Country | US
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Telephone | 417-841-1510
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Fax | 419-841-1513
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Provider Business Mailing Address
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Address Line | 6800 W CENTRAL AVE UNIT K
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City | TOLEDO
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State | OH
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Zip | 43617-1135
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Country | US
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Telephone | 417-841-1510
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Fax | 419-841-1513
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. MARK A WENTZ
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Credential | MD
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Telephone | 419-841-1510
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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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