Basic Information
| Provider Information | |||||||||
| NPI: | 1558408963 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHCOAST WOMENS HEALTH, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 450708 | ||||||||
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| City: | WESTLAKE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441450614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408083700 | ||||||||
| FaxNumber: | 4408083675 | ||||||||
| Practice Location | |||||||||
| Address1: | 1450 BELLE AVE | ||||||||
| Address2: | 300 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441074202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2165298446 | ||||||||
| FaxNumber: | 2165297048 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 12/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | MIKOL | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | M.D. | ||||||||
| AuthorizedOfficialTelephone: | 2165298446 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 35051399M | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0917904 | 05 | OH | MEDICAID |