Provider Demographics
NPI:1376872960
Name:DABMD
Entity Type:Organization
Organization Name:DABMD
Other - Org Name:MED GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-381-9000
Mailing Address - Street 1:13916 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3204
Mailing Address - Country:US
Mailing Address - Phone:216-381-9000
Mailing Address - Fax:216-381-2151
Practice Address - Street 1:13916 CEDAR RD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3204
Practice Address - Country:US
Practice Address - Phone:216-381-9000
Practice Address - Fax:216-381-2151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty