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General NPI Number Information
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NPI Number | 1831506369
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE SURGICAL GROUP OF NORTHEAST OHIO LTD
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Dates
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Enumeration Date | 07/16/2014
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Last Update Date | 07/16/2014
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Provider Practice Location Address
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Address Line | 7645 MARKET ST 200
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City | BOARDMAN
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State | OH
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Zip | 44512-5980
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Country | US
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Telephone | 330-707-0771
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Fax | 330-707-0618
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Provider Business Mailing Address
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Address Line | 7645 MARKET ST. STE# 200
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City | BOARDMAN
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State | OH
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Zip | 44512-5980
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Country | US
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Telephone | 330-707-0771
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Fax | 330-707-0618
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Authorized Official
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Title or Position | PHYSICIAN
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Name | STEPHEN EVAN
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Credential | MD
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Telephone | 330-707-0771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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