Individual
THERESA D AMICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6707 POWERS BLVD, 104, PARMA, OH 44129-5455
(440) 886-2509
Mailing address
PO BOX 932085, CLEVELAND, OH 44193-0001
(888) 328-4492
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
NP-05098
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2335888
—
OH
01
—
P00212878
RAILROAD MEDICARE
OH
Enumeration date
06/09/2006
Last updated
03/16/2011
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