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General NPI Number Information
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NPI Number | 1467817304
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Entity Type | Organization
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Legal Business Name | ADVANCED CARE EMERGENCY MEDICINE GROUP, LLC
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Dates
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Enumeration Date | 12/18/2015
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Last Update Date | 06/13/2016
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Provider Practice Location Address
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Address Line | 950 W WOOSTER ST
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City | BOWLING GREEN
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State | OH
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Zip | 43402-2603
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Country | US
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Telephone | 419-354-8900
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 516
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City | TOLEDO
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State | OH
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Zip | 43697-0516
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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 | FOUNDER/D.O.
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Name | DR. YAZAN MUSALLEM SARSOUR
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Credential | D.O.
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Telephone | 419-373-7642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 34.007644
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License Number State | OH
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