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General NPI Number Information
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NPI Number | 1689793655
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Entity Type | Organization
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Legal Business Name | NORTH COAST GASTROENTEROLOGY, INC
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 07/27/2007
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Provider Practice Location Address
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Address Line | 125 E BROAD ST STE 114
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City | ELYRIA
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State | OH
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Zip | 44035-6429
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Country | US
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Telephone | 440-329-5943
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Fax |
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Provider Business Mailing Address
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Address Line | 125 E BROAD ST STE 114
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City | ELYRIA
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State | OH
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Zip | 44035-6429
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Country | US
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Telephone | 440-329-5943
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES E LISI
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Credential | M.D.
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Telephone | 440-329-5943
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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 |
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License Number State | OH
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