Provider Demographics
NPI:1649645300
Name:MIOARA TUDOSIE, MD, LLC
Entity type:Organization
Organization Name:MIOARA TUDOSIE, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIOARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUDOSIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-455-1511
Mailing Address - Street 1:4347 PORTAGE ST NW STE 102
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7371
Mailing Address - Country:US
Mailing Address - Phone:800-527-0336
Mailing Address - Fax:330-244-8505
Practice Address - Street 1:2600 TUSCARAWAS ST W
Practice Address - Street 2:SUITE 640
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4644
Practice Address - Country:US
Practice Address - Phone:330-455-1511
Practice Address - Fax:330-455-5028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-07
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0152782Medicaid