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General NPI Number Information
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NPI Number | 1649329368
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Entity Type | Organization
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Legal Business Name | METRO GOLDEN MEDICAL, LLC
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 02/12/2019
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Provider Practice Location Address
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Address Line | 414 OAKWOOD AVE
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City | OAKWOOD
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State | OH
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Zip | 45409-2217
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Country | US
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Telephone | 937-548-3063
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 932746
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City | CLEVELAND
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State | OH
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Zip | 44193-2746
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Country | US
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Telephone | 937-548-3063
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Fax | 937-548-1371
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Authorized Official
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Title or Position | OWNER
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Name | RAYMOND S RUSSELL
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Credential | MD
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Telephone | 937-367-4637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35073039
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License Number State | OH
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