Organization
PRO RAD, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN P EWONUS D.O. (PRESIDENT)
(419) 636-1131
Entity
Organization
Contact information
Practice address
433 W HIGH ST, BRYAN, OH 43506-1690
(419) 636-1131
Mailing address
PO BOX 1046, LIMA, OH 45802-1046
(419) 224-5707
(419) 229-0040
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000167003
ANTHEM BCBS
OH
01
—
029599900
FEDERAL BLACK LUNG
OH
01
—
128014000
US DEPT OF LABOR WORKERS
—
05
—
2151595
—
OH
Enumeration date
03/10/2006
Last updated
07/08/2011
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