MEDICARE: PYRAMED HEALTHCARE GROUP, LTD

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

General Provider Information

NPI Number	:	1710101860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PYRAMED HEALTHCARE GROUP, LTD

Provider Business Mailing Address
First Line	:	1120 E BROAD ST
Second Line	:
City	:	ELYRIA
State	:	OH
Zip	:	44035-6306
Country	:	US
Telephone Number	:	440-365-8487
Fax Number	:	440-365-5486

Provider Business Practice Location Address
First Line	:	1120 E BROAD ST
Second Line	:
City	:	ELYRIA
State	:	OH
Zip	:	44035-6306
Country	:	US
Telephone Number	:	440-365-8487
Fax Number	:	440-365-5486

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHARLES M BUTREY
Credential	:	MD
Telephone Number	:	440-365-8487

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	08/22/2020

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