Individual
CHRIST JOHN TICORAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
770 BALGREEN DR, STE 201, MANSFIELD, OH 44906-4106
(419) 756-1600
(419) 775-1196
Mailing address
770 BALGREEN DR, STE 201, MANSFIELD, OH 44906-4106
(419) 756-1600
(419) 775-1196
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
35-06-3717T
OH
207NS0135X
Procedural Dermatology Physician
35-06-3717T
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000199905
BCBS
OH
05
—
2146574
—
OH
Enumeration date
08/03/2005
Last updated
06/22/2010
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