MEDICARE: PHYSICIAN SERVICES OF OHIO LLC

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	2084P0800X	Psychiatry Physician	35081681	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	:	1205053709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIAN SERVICES OF OHIO LLC

Provider Business Mailing Address
First Line	:	2527 MACNAUGHTEN ST NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-9529
Country	:	US
Telephone Number	:	330-361-0908
Fax Number	:	330-305-6762

Provider Business Practice Location Address
First Line	:	2527 MACNAUGHTEN ST NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-9529
Country	:	US
Telephone Number	:	330-361-0908
Fax Number	:	330-305-6762

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	JAVEDUL HAQUE
Credential	:	MD
Telephone Number	:	330-361-0908

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	07/24/2007

Similar Medicare Providers

1174831218 — CANTON PHYSICAL MEDICARE, LLC
Practice Location Address:

2050 CUMMING HWY , SUITE 100
CANTON, GA
30114-8614

Practice Phone: 770-345-9600
Practice Fax:

1942419106 — DR. TIMOTHY WILLIAM FRIEDERICHS M.D.
Practice Location Address:

CORRECTIONAL TRAINING FACILITY , HIGHWAY 101, 4 MILES NORTH OF SOLEDAD
SOLEDAD, CA
93960-9529

Practice Phone: 831-678-3951
Practice Fax: 831-678-5907

1700130051 — KEVIN J LENFEST MS, LADC
Practice Location Address:

128 VT ROUTE 7B NORTH EXT
NORTH CLARENDON, VT
05759-9529

Practice Phone: 802-747-8812
Practice Fax: 844-878-0102

1598139545 — MRS. MELANIE SHIPMAN ED. S.
Practice Location Address:

8867 DURST COLEBROOK RD
NORTH BLOOMFIELD, OH
44450-9529

Practice Phone: 330-505-2800
Practice Fax:

1023900339 — BRETT LEMMA
Practice Location Address:

4815 TONAWANDA CREEK RD
NORTH TONAWANDA, NY
14120-9529

Practice Phone: 716-255-3544
Practice Fax:

1710782024 — ABIGAIL FAULK RN
Practice Location Address:

7171 KECK PARK CIR NW
NORTH CANTON, OH
44720-6301

Practice Phone: 330-437-9529
Practice Fax:

Directions to “PHYSICIAN SERVICES OF OHIO LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.