Basic Information
| Provider Information | |||||||||
| NPI: | 1366435257 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NORTH | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 5700 MONROE ST UNIT 201 | ||||||||
| Address2: | |||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435602735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192912670 | ||||||||
| FaxNumber: | 4194796999 | ||||||||
| Practice Location | |||||||||
| Address1: | 5700 MONROE ST UNIT 201 | ||||||||
| Address2: | |||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435602735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192912670 | ||||||||
| FaxNumber: | 4194796999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2005 | ||||||||
| LastUpdateDate: | 04/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35055613 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00562 | 01 | OH | PHC | OTHER | 080130399 | 01 | OH | RRMC | OTHER | 0670582 | 05 | OH | MEDICAID | 01-03133 | 01 | OH | UHC | OTHER | 30054755-003 | 01 | OH | MMO | OTHER | 000000141260 | 01 | OH | ANTHEM | OTHER | 0634203 | 01 | OH | AETNA | OTHER | 203089 | 01 | OH | BLACK LUNG | OTHER |