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General NPI Number Information
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NPI Number | 1932535820
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Entity Type | Organization
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Legal Business Name | NORTHWEST OHIO RHEUMATOLOGY INC
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Dates
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Enumeration Date | 09/24/2013
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Last Update Date | 10/28/2014
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Provider Practice Location Address
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Address Line | 132 GARAU ST SUITE A
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City | BLUFFTON
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State | OH
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Zip | 45817-1086
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Country | US
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Telephone | 419-358-0132
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Fax | 419-358-0319
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Provider Business Mailing Address
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Address Line | PO BOX 78000 DEPT 78190
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City | DETROIT
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State | MI
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Zip | 48278-1907
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Country | US
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Telephone | 800-514-4390
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Fax | 440-808-3675
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Authorized Official
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Title or Position | OWNER
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Name | JAMES A GIDEON
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Credential | MD
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Telephone | 419-369-2190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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