Organization
MAURICE CONVERSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEIRDRE ANN HARDY (SENIOR CLIENT REP)
(419) 380-0116
Entity
Organization
Contact information
Practice address
6253 W WYANDOTTE RD, MAUMEE, OH 43537-1336
(419) 865-4464
Mailing address
6253 W WYANDOTTE RD, MAUMEE, OH 43537-1336
(419) 865-4464
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
35020368C
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0107226
—
OH
Enumeration date
02/01/2008
Last updated
02/01/2008
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