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General NPI Number Information
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NPI Number | 1477753911
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Entity Type | Organization
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Legal Business Name | TRI COUNTY DERMATOLOGY, INC.
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 10/23/2007
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Provider Practice Location Address
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Address Line | 4240 MUNSON ST NW
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City | CANTON
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State | OH
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Zip | 44718-2981
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Country | US
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Telephone | 330-492-2327
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Fax |
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Provider Business Mailing Address
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Address Line | 4240 MUNSON ST NW
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City | CANTON
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State | OH
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Zip | 44718-2981
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Country | US
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Telephone | 330-492-2327
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SCHIELD MARTIN WIKAS
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Credential | DO
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Telephone | 330-492-2327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State | OH
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