Basic Information
| Provider Information | |||||||||
| NPI: | 1023015351 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HORVATH | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5308 HARROUN RD | ||||||||
| Address2: | SUITE 055 | ||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435602114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198246599 | ||||||||
| FaxNumber: | 4198853870 | ||||||||
| Practice Location | |||||||||
| Address1: | 5308 HARROUN RD | ||||||||
| Address2: | SUITE 055 | ||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435602114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198246599 | ||||||||
| FaxNumber: | 4198853870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2005 | ||||||||
| LastUpdateDate: | 05/01/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 35038120 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 4301058940 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | H00419406 | 01 | OH | MEDICARE | OTHER | P00934620 | 01 | OH | RRMC | OTHER | 0294079 | 05 | OH | MEDICAID |