MEDICARE: CHILDREN'S INTENSIVE CARING, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	3506690P	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013156710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S INTENSIVE CARING, INC.

Provider Business Mailing Address
First Line	:	4405 N HOLLAND SYLVANIA RD
Second Line	:	SUITE 102
City	:	TOLEDO
State	:	OH
Zip	:	43623-3529
Country	:	US
Telephone Number	:	419-841-0772
Fax Number	:	419-841-0894

Provider Business Practice Location Address
First Line	:	4405 N HOLLAND SYLVANIA RD
Second Line	:	SUITE 102
City	:	TOLEDO
State	:	OH
Zip	:	43623-3529
Country	:	US
Telephone Number	:	419-841-0772
Fax Number	:	419-841-0894

Authorized Official
Title or Position	:	M.D.
Name	:	MICHAEL D. PAPPAS
Credential	:	M.D.
Telephone Number	:	419-841-0772

Provider Enumeration Date	:	02/19/2009
Last Update Date	:	02/19/2009

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