Provider Demographics
NPI:1437376621
Name:PULMONARY MEDICINE CONSULTANTS
Entity Type:Organization
Organization Name:PULMONARY MEDICINE CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARIJO
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHUNTICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-758-7575
Mailing Address - Street 1:925 TRAILWOOD DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5008
Mailing Address - Country:US
Mailing Address - Phone:330-758-7575
Mailing Address - Fax:330-758-1833
Practice Address - Street 1:925 TRAILWOOD DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-5008
Practice Address - Country:US
Practice Address - Phone:330-758-7575
Practice Address - Fax:330-758-1833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH258785OtherBLACK LUNG
OH34161789700OtherBWC
OH0736538Medicaid
OH0736538Medicaid