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General NPI Number Information
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NPI Number | 1215971643
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Entity Type | Organization
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Legal Business Name | MILLERSBURG CLINIC, INC.
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 01/24/2019
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Provider Practice Location Address
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Address Line | 5354 TOWNSHIP ROAD 336 STE B
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City | MILLERSBURG
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State | OH
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Zip | 44654
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Country | US
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Telephone | 330-674-3434
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Fax | 330-674-3731
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Provider Business Mailing Address
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Address Line | 5354 TOWNSHIP ROAD 336 STE B
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City | MILLERSBURG
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State | OH
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Zip | 44654
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Country | US
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Telephone | 330-674-3434
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Fax | 330-674-3731
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Authorized Official
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Title or Position | MD
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Name | BUTROS LATOUF
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Credential | MD
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Telephone | 330-674-3434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 350631710
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License Number State | OH
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