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General NPI Number Information
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NPI Number | 1336340504
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Entity Type | Organization
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Legal Business Name | UNIVERSITY PRIMARY CARE PRACTICES INC
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 06/13/2024
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Provider Practice Location Address
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Address Line | 145 WEST AVE STE 2
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City | TALLMADGE
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State | OH
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Zip | 44278
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Country | US
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Telephone | 330-633-8341
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Fax | 330-633-8462
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Provider Business Mailing Address
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Address Line | PO BOX 772928
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City | DETROIT
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State | MI
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Zip | 48277-2928
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CMO, EAST MARKET
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Name | DR. DONALD DECARLO
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Credential | MD
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Telephone | 440-285-2950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State | OH
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