Organization
MOBILE PHYSICIANS OF OHIO INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL WALLACE O.D. (PRESIDENT)
(419) 882-5000
Entity
Organization
Contact information
Practice address
5151 MAIN ST, SYLVANIA, OH 43560-2184
(419) 882-5000
(419) 882-5008
Mailing address
5151 MAIN ST, SYLVANIA, OH 43560-2184
(419) 882-5000
(419) 882-5008
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
364S00000X
Clinical Nurse Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2778392
—
OH
Enumeration date
03/03/2008
Last updated
03/03/2008
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