Provider Demographics
NPI:1982656633
Name:ROBERT MARK FUMICH, M.D., INC.
Entity Type:Organization
Organization Name:ROBERT MARK FUMICH, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:FUMICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-460-0454
Mailing Address - Street 1:6803 MAYFIELD RD
Mailing Address - Street 2:SUITE 314
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2271
Mailing Address - Country:US
Mailing Address - Phone:440-460-0454
Mailing Address - Fax:440-460-0492
Practice Address - Street 1:6803 MAYFIELD RD
Practice Address - Street 2:SUITE 314
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2271
Practice Address - Country:US
Practice Address - Phone:440-460-0454
Practice Address - Fax:440-460-0492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-8194207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRO0470823OtherMEDICARE
OH121721000OtherUS DEPT OF LABOR
OH0425383Medicaid
OH000000027306OtherANTHEM BC/BS
OH276463151001OtherCENTRAL RESERVE LIFE
OHDH0806OtherMEDICARE RAILROAD
OH276463151003OtherMEDICAL MUTUAL OF OHIO
OH276463151003OtherMEDICAL MUTUAL OF OHIO
OHRO0470823OtherMEDICARE
OH276463151003OtherMEDICAL MUTUAL OF OHIO