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General NPI Number Information
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NPI Number | 1376645176
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Entity Type | Organization
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Legal Business Name | MAPLE FAMILY PHYSICIANS INC
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 15003 TURNEY RD
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City | MAPLE HEIGHTS
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State | OH
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Zip | 44137-4730
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Country | US
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Telephone | 216-663-7753
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Fax | 216-663-0897
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Provider Business Mailing Address
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Address Line | 15003 TURNEY RD
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City | MAPLE HEIGHTS
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State | OH
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Zip | 44137-4730
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Country | US
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Telephone | 216-663-7753
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Fax | 216-663-0897
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Authorized Official
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Title or Position | PRESIDENT
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Name | EUGENE S BALKOVEC
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Credential | DO
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Telephone | 216-663-7753
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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