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General NPI Number Information
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NPI Number | 1306105150
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Entity Type | Organization
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Legal Business Name | PROMEDICA MULTI SPECIALTY PHYSICIANS
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Dates
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Enumeration Date | 05/15/2012
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 100 MADISON AVE MSC-S38805
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City | TOLEDO
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State | OH
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Zip | 43604-1531
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Country | US
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Telephone | 567-585-1964
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Fax | 419-824-7359
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Provider Business Mailing Address
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Address Line | 100 MADISON AVE MSC-S38805
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City | TOLEDO
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State | OH
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Zip | 43604-1531
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Country | US
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Telephone | 567-585-1964
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Fax | 419-824-7359
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | LORRAINE MCCUNE
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Credential |
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Telephone | 567-585-1964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State | OH
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Taxonomy #8
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #10
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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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Taxonomy #11
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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Taxonomy #12
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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 | OH
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