Organization
PORTAGE REGIONAL GASTROENTEROLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL S CLINE DO (OWNER)
(330) 296-7256
Entity
Organization
Contact information
Practice address
330 N CHESTNUT ST, RAVENNA, OH 44266-2287
(330) 296-7256
(330) 296-0127
Mailing address
330 N CHESTNUT ST, RAVENNA, OH 44266-2287
(330) 296-7256
(330) 296-0127
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0131593
—
OH
Enumeration date
10/18/2007
Last updated
10/18/2007
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