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General NPI Number Information
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NPI Number | 1891942579
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Entity Type | Organization
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Legal Business Name | NORTH OHIO GASTROENTEROLOGY
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Dates
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Enumeration Date | 08/25/2008
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Last Update Date | 08/01/2012
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Provider Practice Location Address
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Address Line | 30701 CLEMENS ROAD
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City | WESTLAKE
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State | OH
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Zip | 44145
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Country | US
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Telephone | 440-617-1212
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Fax | 440-617-1213
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Provider Business Mailing Address
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Address Line | 30701 CLEMENS ROAD
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City | WESTLAKE
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State | OH
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Zip | 44145-1493
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Country | US
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Telephone | 440-617-1212
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Fax | 440-617-1213
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | PETRA BOESINGER
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Credential |
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Telephone | 440-617-1212
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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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Taxonomy #2
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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 |
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