Basic Information
| Provider Information | |||||||||
| NPI: | 1467817304 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED CARE EMERGENCY MEDICINE GROUP, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 516 | ||||||||
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| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436970516 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 950 W WOOSTER ST | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434022603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193548900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2015 | ||||||||
| LastUpdateDate: | 06/13/2016 | ||||||||
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| AuthorizedOfficialLastName: | SARSOUR | ||||||||
| AuthorizedOfficialFirstName: | YAZAN | ||||||||
| AuthorizedOfficialMiddleName: | MUSALLEM | ||||||||
| AuthorizedOfficialTitleorPosition: | FOUNDER/D.O. | ||||||||
| AuthorizedOfficialTelephone: | 4193737642 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 34.007644 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.