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Individual

BRYAN SHANLEY SACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2222 CHERRY ST STE 1800, TOLEDO, OH 43608-2679
(419) 251-4300
Mailing address
2222 CHERRY ST STE 1800, TOLEDO, OH 43608-2679
(419) 251-4300

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
35.149791
OH
208800000X
Urology Physician
4301114274
MI
2088P0231X
Pediatric Urology Physician
Primary
35.149791
OH
2088P0231X
Pediatric Urology Physician
4301114274
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0433417
OH
01
H0013934-NWPS
CGS
OH
01
H0024826-CSA
CGS
OH
Enumeration date
03/29/2010
Last updated
11/19/2024
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