Organization
PROMEDICA CENTRAL PHYSICIANS, LLC
Active
Organization
PROMEDICA CENTRAL PHYSICIANS, LLC
Active
Other names
Pediatric and Adolescent Gastroenterology and Nutrition Team
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY GOVAN (CREDENTIALING SPECIALIST)
(419) 824-7221
Entity
Organization
Contact information
Practice address
2109 HUGHES DR, SUITE 860, TOLEDO, OH 43606-3856
(419) 291-7010
(419) 479-6917
Mailing address
2109 HUGHES DR, SUITE 860, TOLEDO, OH 43606-3856
(419) 291-7010
(419) 479-6917
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0999273
—
OH
01
—
7075625
AETNA
OH
01
—
CI3157
RRMC
OH
Enumeration date
02/21/2007
Last updated
07/21/2022
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