Basic Information
| Provider Information | |||||||||
| NPI: | 1184369795 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TURK | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | JOHN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8572 WINDSOR WAY | ||||||||
| Address2: | |||||||||
| City: | BROADVIEW HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441471790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4407818276 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6001 E BROAD ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432131502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145520061 | ||||||||
| FaxNumber: | 6145520168 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2022 | ||||||||
| LastUpdateDate: | 04/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367H00000X | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Anesthesiologist Assistant |
No ID Information.