Organization Name: | MEDXM |
NPI Number: | 1073948808 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MATTHEW MANN MINARIK (PHYSICIAN ASSISTANT) |
Mailing Address: | 21576 N Park Dr Fairview Park |
State: | OH US |
Postal Code: | 441262324 |
Phone Number: | 4407246363 |
Fax Number: | |
NPI Enumeration Date: | 09/11/2013 |
NPI Last Update Date: | 09/11/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 385H00000X |
License Number: | 5601006700 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Respite Care Facility |
Taxonomy Classification: | Respite Care |
Taxonomy Specialization: | |
Taxonomy Definition: |