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Organization
MIRHAIDARI FAMILY PRACTICE
Active
Organization
MIRHAIDARI FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHADY TAGGART (BILLING)
(330) 364-8884
Entity
Organization
Contact information
Practice address
152 N BROADWAY ST STE 100, NEW PHILADELPHIA, OH 44663-2665
(330) 364-8884
Mailing address
152 N BROADWAY ST STE 100, NEW PHILADELPHIA, OH 44663-2665
(330) 364-8884
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34-008184
OH
363L00000X
Nurse Practitioner
APRNCNP15213
OH
Other
Enumeration date
05/24/2017
Last updated
05/24/2017
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