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General NPI Number Information
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NPI Number | 1144554320
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Entity Type | Organization
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Legal Business Name | DIABETES MANAGEMENT TEAM
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 09/22/2009
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Provider Practice Location Address
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Address Line | 23250 CHAGRIN BLVD SUITE 201
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City | BEACHWOOD
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State | OH
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Zip | 44122-5470
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Country | US
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Telephone | 216-504-8888
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Fax | 216-504-8887
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Provider Business Mailing Address
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Address Line | 23250 CHAGRIN BLVD SUITE 201
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City | BEACHWOOD
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State | OH
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Zip | 44122-5470
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Country | US
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Telephone | 216-504-8888
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Fax | 216-504-8887
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ANNE M CARROL
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Credential | M.D.
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Telephone | 216-504-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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