MEDICARE: DR. STEFAN COSMIN IACOB M.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	207Q00000X	Family Medicine Physician	35.140189	OH

General Provider Information

NPI Number	:	1508353590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEFAN COSMIN IACOB M.D.

Provider Business Mailing Address
First Line	:	27 ST LAWRENCE DR STE 103
Second Line	:
City	:	TIFFIN
State	:	OH
Zip	:	44883-8313
Country	:	US
Telephone Number	:	419-448-4622
Fax Number	:

Provider Business Practice Location Address
First Line	:	27 ST LAWRENCE DR STE 103
Second Line	:
City	:	TIFFIN
State	:	OH
Zip	:	44883-8313
Country	:	US
Telephone Number	:	419-448-4622
Fax Number	:

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

Provider Enumeration Date	:	04/16/2018
Last Update Date	:	06/30/2021

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