Organization
PROMEDICA CENTRAL PHYSICIANS
Active
Other names
ProMedica Physicians Podiatry
Organization subpart
No
Provider details
NPI number
Authorized official
LORRAINE MCCUNE (CREDENTIALING SPECIALIST)
(567) 585-1964
Entity
Organization
Contact information
Practice address
5300 HARROUN RD STE 201, SYLVANIA, OH 43560-2146
(419) 885-5563
(419) 885-5439
Mailing address
100 MADISON AVE # S38805, TOLEDO, OH 43604-1516
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
—
OH
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4036950014
DME
OH
Enumeration date
04/10/2015
Last updated
07/15/2024
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