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General NPI Number Information
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NPI Number | 1518445915
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Entity Type | Organization
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Legal Business Name | LIMA-UMADAOP LLC
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Dates
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Enumeration Date | 07/30/2018
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Last Update Date | 07/30/2018
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Provider Practice Location Address
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Address Line | 3491 STATE ROUTE 108
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City | WAUSEON
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State | OH
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Zip | 43567-9410
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Country | US
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Telephone | 419-720-9255
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Fax |
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Provider Business Mailing Address
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Address Line | 3491 STATE ROUTE 108
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City | WAUSEON
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State | OH
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Zip | 43567-9410
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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 | MANAGER
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Name | MICHELLE WALSH
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Credential |
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Telephone | 219-213-2380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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