| NPI | 1790114197 |
|---|---|
| Doing Business As | PROVIDENCE FAMILY MEDICINE DUTCHFORK |
| Entity Type | Organization |
| Authorized Contact | KELLY A MOWRER Credentialing Specialist 216-472-2741 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2013-11-06 |
| Last Update Date | 2013-11-06 |