Individual
MICHAEL ST. MARIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2420 LAKE AVE, ASHTABULA, OH 44004-4954
(440) 997-2262
Mailing address
32945 CANTERBURY RD, AVON LAKE, OH 44012-1587
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35064462S
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0573937
—
OH
01
—
942460636340
CARESOURCE
OH
01
—
P00220354
MEDICARE TRAVELERS RR-GA
OH
Enumeration date
05/27/2006
Last updated
07/08/2007
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