NPI | 1548593361 |
---|---|
Entity Type | Organization |
Authorized Contact | MISTY BLAYLOCK Credentialing Coordinator 440-892-6406 |
Organization Subpart ? | No |
Primary Taxonomy | 208000000X Pediatrics |
Additional Taxonomies | 207Q00000X Family Medicine |
Enumeration Date | 2009-09-11 |
Last Update Date | 2009-09-11 |