MEDICARE: MYRON G. ZUDER PH. D.

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	106H00000X	Marriage & Family Therapist	E.0001405	OH

General Provider Information

NPI Number	:	1194977793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYRON G. ZUDER PH. D.

Provider Business Mailing Address
First Line	:	640 N MAIN ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44310-3017
Country	:	US
Telephone Number	:	330-762-7481
Fax Number	:	330-762-7484

Provider Business Practice Location Address
First Line	:	640 N MAIN ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44310-3017
Country	:	US
Telephone Number	:	330-762-7481
Fax Number	:	330-762-7484

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2008
Last Update Date	:	10/15/2008

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