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General NPI Number Information
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NPI Number | 1659193746
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Entity Type | Organization
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Legal Business Name | ALMADELIC MEDICAL GROUP OHA CORP
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 6545 MARKET AVE N STE 100
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City | CANTON
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State | OH
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Zip | 44721-2430
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Country | US
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Telephone | 303-521-0533
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Fax |
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Provider Business Mailing Address
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Address Line | 1385 S COLORADO BLVD # A712
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City | DENVER
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State | CO
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Zip | 80222-3304
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Country | US
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Telephone | 303-521-0533
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | KIRILL MERKULOV
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Credential |
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Telephone | 303-521-0533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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