Basic Information
| Provider Information | |||||||||
| NPI: | 1376872960 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DABMD | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MED GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13916 CEDAR RD | ||||||||
| Address2: | |||||||||
| City: | UNIVERSITY HTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441183204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2163819000 | ||||||||
| FaxNumber: | 2163812151 | ||||||||
| Practice Location | |||||||||
| Address1: | 13916 CEDAR RD | ||||||||
| Address2: | |||||||||
| City: | UNIVERSITY HTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441183204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2163819000 | ||||||||
| FaxNumber: | 2163812151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2009 | ||||||||
| LastUpdateDate: | 04/23/2010 | ||||||||
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| AuthorizedOfficialLastName: | KATZAKIS | ||||||||
| AuthorizedOfficialFirstName: | MARIA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2163819000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 208D00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.