# PROMEDICA MULTI SPECIALTY PHYSICIANS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306105150
- **Authorized official:** LORRAINE MCCUNE (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (567) 585-1964

## Contact information

- **Practice address:** 100 MADISON AVE, MSC-S38805, TOLEDO, OH 43604-1531
- **Practice address phone:** (567) 585-1964
- **Practice address fax:** (419) 824-7359
- **Mailing address:** 100 MADISON AVE, MSC-S38805, TOLEDO, OH 43604-1531
- **Mailing address phone:** (567) 585-1964
- **Mailing address fax:** (419) 824-7359

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | OH | Yes |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | OH | — |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | NULL | — |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | — |
| 207RH0003X | Hematology & Oncology Physician | — | NULL | — |
| 207RH0003X | Hematology & Oncology Physician | — | — | — |
| 207RI0200X | Infectious Disease Physician | — | NULL | — |
| 207RI0200X | Infectious Disease Physician | — | — | — |
| 207RP1001X | Pulmonary Disease Physician | — | NULL | — |
| 207RP1001X | Pulmonary Disease Physician | — | — | — |
| 207RS0012X | Sleep Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RS0012X | Sleep Medicine (Internal Medicine) Physician | — | — | — |
| 207Y00000X | Otolaryngology Physician | — | NULL | — |
| 207Y00000X | Otolaryngology Physician | — | — | — |
| 2084N0400X | Neurology Physician | — | NULL | — |
| 2084N0400X | Neurology Physician | — | — | — |
| 2086S0122X | Plastic and Reconstructive Surgery Physician | — | OH | — |
| 2086S0129X | Vascular Surgery Physician | — | NULL | — |
| 2086S0129X | Vascular Surgery Physician | — | — | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 05/15/2012
- **Last updated:** 12/16/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0065185 | — | OH |