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General NPI Number Information
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NPI Number | 1114974219
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Entity Type | Individual
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Provider Name | MICHAEL ST. MARIE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2420 LAKE AVE
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City | ASHTABULA
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State | OH
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Zip | 44004-4954
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Country | US
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Telephone | 440-997-2262
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Fax |
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Provider Business Mailing Address
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Address Line | 32945 CANTERBURY RD
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City | AVON LAKE
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State | OH
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Zip | 44012-1587
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 35064462S
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License Number State | OH
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