Individual
STACEY MARDIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
630 E RIVER ST, DEPARTMENT OF EMERGENCY MEDICINE, ELYRIA, OH 44035-5902
(440) 329-7450
Mailing address
630 E RIVER ST, DEPARTMENT OF EMERGENCY MEDICINE, ELYRIA, OH 44035-5902
(440) 329-7450
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35.121170
OH
207Q00000X
Family Medicine Physician
35.121170
OH
Other
Enumeration date
07/12/2010
Last updated
07/01/2013
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