MEDICARE: LONNA LOUISE SAFKO 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	390200000X	Student in an Organized Health Care Education/Training Program	57-015212	OH
2	207Q00000X	Family Medicine Physician	35-097284	OH

General Provider Information

NPI Number	:	1851543664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LONNA LOUISE SAFKO M.D.

Provider Business Mailing Address
First Line	:	1403 CHANNONBROOK ST SW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44710-1274
Country	:	US
Telephone Number	:	330-524-6407
Fax Number	:

Provider Business Practice Location Address
First Line	:	9318 STATE ROUTE 14
Second Line	:	2ND FLOOR
City	:	STREETSBORO
State	:	OH
Zip	:	44241-5224
Country	:	US
Telephone Number	:	330-626-3111
Fax Number	:	330-626-5978

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

Provider Enumeration Date	:	10/13/2008
Last Update Date	:	08/04/2011

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