MEDICARE: WILLGLOWE HEALTH SERVICES, INC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1720609217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLGLOWE HEALTH SERVICES, INC

Provider Business Mailing Address
First Line	:	PO BOX 2165
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-0165
Country	:	US
Telephone Number	:	330-361-0329
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 E MAPLE ST
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-9997
Country	:	US
Telephone Number	:	330-361-0329
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	GLORIA J KOOMSON
Credential	:	MD
Telephone Number	:	216-200-1791

Provider Enumeration Date	:	05/06/2020
Last Update Date	:	10/12/2020

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Directions to “WILLGLOWE HEALTH SERVICES, INC ” Practice Location

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