Individual
DR. MATTHEW LICAUSE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6512 WHIPPLE AVE NW, NORTH CANTON, OH 44720-7340
(330) 499-5600
Mailing address
3031 MIDVALE RD NW, CANTON, OH 44718-3237
(330) 499-5600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35055573
OH
Other
Enumeration date
04/17/2006
Last updated
07/08/2007
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