Organization
MID OHIO INFECTIOUS DISEASES CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. UCHENNA A EZIKE MD (OWNER/PRESIDENT)
(412) 708-1608
Entity
Organization
Contact information
Practice address
630 LEXINGTON AVE, MANSFIELD, OH 44907-1500
(412) 708-1608
Mailing address
PO BOX 5096, MANSFIELD, OH 44901-5096
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
35093594
OH
Other
Enumeration date
07/16/2009
Last updated
07/16/2009
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