Provider Demographics
NPI:1386674562
Name:NORTHWEST OHIO PRIMARY CARE PHYSICIANS, INC
Entity Type:Organization
Organization Name:NORTHWEST OHIO PRIMARY CARE PHYSICIANS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GLADIEUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-887-0803
Mailing Address - Street 1:5757 MONCLOVA RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1863
Mailing Address - Country:US
Mailing Address - Phone:419-887-0803
Mailing Address - Fax:419-887-0817
Practice Address - Street 1:5757 MONCLOVA RD
Practice Address - Street 2:SUITE 10
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1863
Practice Address - Country:US
Practice Address - Phone:419-887-0803
Practice Address - Fax:419-887-0817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35056893208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1891790804OtherNPI
OH0735459Medicaid
1891790804OtherNPI
OH0735459Medicaid