Provider Demographics
NPI:1851543664
Name:SAFKO, LONNA LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:LONNA
Middle Name:LOUISE
Last Name:SAFKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 CHANNONBROOK ST SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-1274
Mailing Address - Country:US
Mailing Address - Phone:330-524-6407
Mailing Address - Fax:
Practice Address - Street 1:9318 STATE ROUTE 14
Practice Address - Street 2:2ND FLOOR
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5224
Practice Address - Country:US
Practice Address - Phone:330-626-3111
Practice Address - Fax:330-626-5978
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57-015212390200000X
OH35-097284207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program