Provider Demographics
NPI:1578600862
Name:MAUMEE FAMILY PHYSICIANS INC
Entity Type:Organization
Organization Name:MAUMEE FAMILY PHYSICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT MD
Authorized Official - Prefix:
Authorized Official - First Name:NERIEL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:BERNBLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-893-1971
Mailing Address - Street 1:120 W DUDLEY ST
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537
Mailing Address - Country:US
Mailing Address - Phone:419-893-1971
Mailing Address - Fax:419-893-2321
Practice Address - Street 1:120 W DUDLEY ST
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537
Practice Address - Country:US
Practice Address - Phone:419-893-1971
Practice Address - Fax:419-893-2321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH38677207Q00000X
OH40287207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty