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General NPI Number Information
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NPI Number | 1811221153
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Entity Type | Individual
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Provider Name | MICHAEL DAVID STORMONT M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/18/2009
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Last Update Date | 01/27/2021
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Provider Practice Location Address
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Address Line | 800 PORTLAND WAY N
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City | GALION
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State | OH
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Zip | 44833-1156
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Country | US
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Telephone | 419-462-3425
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Fax |
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Provider Business Mailing Address
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Address Line | 700 N COLUMBUS ST
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City | CRESTLINE
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State | OH
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Zip | 44827-1455
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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 |
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Name |
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Credential |
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Telephone |
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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 | 35.098727
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License Number State | OH
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