Individual
DR. LAURA M. DISTEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
185 WADSWORTH RD, SUITE D, WADSWORTH, OH 44281-8330
(330) 331-7106
(330) 331-7556
Mailing address
185 WADSWORTH RD, SUITE D, WADSWORTH, OH 44281-8330
(330) 331-7106
(330) 331-7556
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35093592
OH
207QS0010X
Sports Medicine (Family Medicine) Physician
35093592
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3090926
—
OH
Enumeration date
03/26/2007
Last updated
01/18/2018
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