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General NPI Number Information
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NPI Number | 1790826535
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Entity Type | Organization
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Legal Business Name | PROMEDICA CENTRAL PHYSICIAN, LLC
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 02/18/2008
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Provider Practice Location Address
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Address Line | 3740 W SYLVANIA AVE SUITE 103
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City | TOLEDO
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State | OH
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Zip | 43623-4461
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Country | US
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Telephone | 419-473-6622
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Fax | 419-473-6627
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Provider Business Mailing Address
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Address Line | 3740 W SYLVANIA AVE SUITE 103
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City | TOLEDO
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State | OH
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Zip | 43623-4461
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Country | US
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Telephone | 419-473-6622
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Fax | 419-473-6627
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Authorized Official
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Title or Position | CREDENTIALING ASSISTANT
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Name | KENYA DIXON
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Credential |
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Telephone | 419-824-7288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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