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General NPI Number Information
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NPI Number | 1730194598
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICINE OF STARK COUNTY, INC.
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 07/09/2008
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Provider Practice Location Address
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Address Line | 6512 WHIPPLE AVE NW
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City | NORTH CANTON
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State | OH
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Zip | 44720-7340
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Country | US
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Telephone | 330-499-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 6512 WHIPPLE AVE NW
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City | NORTH CANTON
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State | OH
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Zip | 44720-7340
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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 | PRESIDENT
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Name | DR. GUST PANTELAS
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Credential |
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Telephone | 330-499-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 056025
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License Number State | OH
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