Organization Name: | UPPER SANDUSKY MEDICAL ASSOC INC |
NPI Number: | 1215936075 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KONSTANTINE K SOLACOFF (CORPORATION PRESIDENT) |
Mailing Address: | 777 N Sandusky Ave Upper Sandusky |
State: | OH US |
Postal Code: | 433511075 |
Phone Number: | 4192942375 |
Fax Number: | 4192942412 |
NPI Enumeration Date: | 07/14/2005 |
NPI Last Update Date: | 04/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ========= |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |