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General NPI Number Information
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NPI Number | 1457474330
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Entity Type | Organization
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Legal Business Name | JACK ANSTANDIG, M.D., INC.
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Dates
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Enumeration Date | 04/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 34900 CHARDON RD SUITE #201
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City | WILLOUGHBY
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State | OH
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Zip | 44094-9161
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Country | US
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Telephone | 440-269-1550
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Fax | 440-269-1750
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Provider Business Mailing Address
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Address Line | 34900 CHARDON RD SUITE #201
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City | WILLOUGHBY
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State | OH
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Zip | 44094-9161
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Country | US
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Telephone | 440-269-1550
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Fax | 440-269-1750
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACK ANSTANDIG
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Credential | M.D.
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Telephone | 440-269-1550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 35-05-2146
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License Number State | OH
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