Provider Demographics
NPI:1407299878
Name:PROMEDICA CENTRAL PHYSICIANS LLC
Entity Type:Organization
Organization Name:PROMEDICA CENTRAL PHYSICIANS LLC
Other - Org Name:ARUN D MATHUR MD
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAHNSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-824-7334
Mailing Address - Street 1:5308 HARROUN RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2114
Mailing Address - Country:US
Mailing Address - Phone:419-824-1999
Mailing Address - Fax:419-882-7016
Practice Address - Street 1:5308 HARROUN RD
Practice Address - Street 2:SUITE 170
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2114
Practice Address - Country:US
Practice Address - Phone:419-824-1999
Practice Address - Fax:419-882-7016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty