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General NPI Number Information
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NPI Number | 1124159686
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Entity Type | Organization
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Legal Business Name | HARRY M HUMENIUK MD INC
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 4935 HARROUN RD
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City | SYLVANIA
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State | OH
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Zip | 43560-2107
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Country | US
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Telephone | 419-885-7546
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Fax | 419-882-4969
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Provider Business Mailing Address
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Address Line | 4935 HARROUN RD
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City | SYLVANIA
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State | OH
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Zip | 43560-2107
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Country | US
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Telephone | 419-885-7546
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Fax | 419-882-4969
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Authorized Official
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Title or Position | OWNER, PRESIDENT
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Name | DR. HARRY MICHAEL HUMENIUK
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Credential | M.D.
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Telephone | 419-886-7546
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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 | 34007965B
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 35061843
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License Number State | OH
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