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General NPI Number Information
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NPI Number | 1669817094
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Entity Type | Organization
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Legal Business Name | UNIVERSITY PRIMARY CARE PRACTICES INC
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Dates
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Enumeration Date | 04/29/2013
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Last Update Date | 06/13/2024
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Provider Practice Location Address
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Address Line | 96 GRAHAM RD STE B
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City | CUYAHOGA FALLS
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State | OH
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Zip | 44223-1292
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Country | US
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Telephone | 330-923-0553
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Fax | 330-923-0556
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Provider Business Mailing Address
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Address Line | PO BOX 772928
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City | DETROIT
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State | MI
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Zip | 48277-2928
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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 | CMO, EAST MARKET
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Name | DR. DONALD DECARLO
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Credential | MD
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Telephone | 440-796-8827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State | OH
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