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NPI Code Detail

MEDICARE: MICHAEL JOSEPH DEVINE III MD

MEDICARE: MICHAEL JOSEPH DEVINE III MD
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
1174400000XSpecialist35057955OH
2207R00000XInternal Medicine Physician35057955OH

Other Identifiers

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

General Provider Information

NPI Number : 1245219419
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL JOSEPH DEVINE III MD
Provider Business Mailing Address
First Line : 1450 S CANFIELD NILES RD
Second Line :
City : AUSTINTOWN
State : OH
Zip : 44515-4085
Country : US
Telephone Number : 330-792-7495
Fax Number : 330-797-1562
Provider Business Practice Location Address
First Line : 1450 S CANFIELD NILES RD
Second Line :
City : AUSTINTOWN
State : OH
Zip : 44515-4085
Country : US
Telephone Number : 330-792-7495
Fax Number : 330-797-1562
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2006
Last Update Date : 12/14/2016

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