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General NPI Number Information
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NPI Number | 1336229590
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Entity Type | Organization
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Legal Business Name | MYTON MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 03/17/2014
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Provider Practice Location Address
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Address Line | 3619 PARK EAST DR 205 S
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City | BEACHWOOD
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State | OH
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Zip | 44122-4330
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Country | US
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Telephone | 216-591-0942
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Fax | 440-834-1902
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Provider Business Mailing Address
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Address Line | 3619 PARK EAST DR 205 S
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City | BEACHWOOD
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State | OH
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Zip | 44122-4330
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Country | US
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Telephone | 216-591-0942
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Fax | 440-834-1902
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Authorized Official
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Title or Position | OWNER
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Name | DR. KAYE MYTON-CRAIG
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Credential | MD
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Telephone | 216-591-0942
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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 | 35067681
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License Number State | OH
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