Provider Demographics
NPI:1568504223
Name:ARTHRITIS CLINIC OF PERRYSBURG INC
Entity Type:Organization
Organization Name:ARTHRITIS CLINIC OF PERRYSBURG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAUSEEF
Authorized Official - Middle Name:G
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-874-1566
Mailing Address - Street 1:900 W SOUTH BOUNDARY ST
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5230
Mailing Address - Country:US
Mailing Address - Phone:419-874-1566
Mailing Address - Fax:419-874-1547
Practice Address - Street 1:900 W SOUTH BOUNDARY ST
Practice Address - Street 2:BLDG 5B
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5230
Practice Address - Country:US
Practice Address - Phone:419-874-1566
Practice Address - Fax:419-874-1547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3012073Medicaid
OHAR9383911Medicare PIN