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NPI Code Detail

MEDICARE: MR. KOREY A MCCREERY COPRS-S

MEDICARE: MR. KOREY A MCCREERY COPRS-S
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
1175T00000XPeer SpecialistOH

General Provider Information

NPI Number : 1619512787
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KOREY A MCCREERY COPRS-S
Provider Business Mailing Address
First Line : 159 FROMM AVE NW
Second Line :
City : CANTON
State : OH
Zip : 44708-5005
Country : US
Telephone Number : 234-214-9731
Fax Number :
Provider Business Practice Location Address
First Line : 3311 12TH ST NW
Second Line :
City : CANTON
State : OH
Zip : 44708-3909
Country : US
Telephone Number : 234-214-9731
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2019
Last Update Date : 11/13/2019

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