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NPI Code Detail

MEDICARE: SANDUSKY MEDICAL & PAIN CLINIC

MEDICARE: SANDUSKY MEDICAL & PAIN CLINIC
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
1207Q00000XFamily Medicine Physician35074103OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902080310
Entity Type Code : Organization
Provider Name (Legal Business Name) : SANDUSKY MEDICAL & PAIN CLINIC
Provider Business Mailing Address
First Line : 208 E PERKINS AVE
Second Line :
City : SANDUSKY
State : OH
Zip : 44870-4905
Country : US
Telephone Number : 419-621-1555
Fax Number : 419-621-1405
Provider Business Practice Location Address
First Line : 208 E PERKINS AVE
Second Line :
City : SANDUSKY
State : OH
Zip : 44870-4905
Country : US
Telephone Number : 419-621-1555
Fax Number : 419-621-1405
Authorized Official
Title or Position : OWNER
Name : DR. ISSAM AHMAD AL-TURK
Credential : M.D.
Telephone Number : 419-621-1555
Provider Enumeration Date : 12/20/2007
Last Update Date : 05/01/2008

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Directions to “SANDUSKY MEDICAL & PAIN CLINIC ” Practice Location

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