Provider Demographics
NPI:1720088859
Name:GEDEON, MICHAEL R (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:GEDEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 MASSILLON RD
Mailing Address - Street 2:STE 300
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7854
Mailing Address - Country:US
Mailing Address - Phone:330-376-1071
Mailing Address - Fax:330-376-0130
Practice Address - Street 1:150 SPRINGSIDE DR STE 320C
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-2486
Practice Address - Country:US
Practice Address - Phone:330-376-1071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055402207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2220539OtherAETNA
OH000000130500OtherANTHEM
ND110035989OtherRR MEDICARE
OH0402221OtherUHC
OH0726772Medicaid
OH341330708OtherCIGNA
OHD97909Medicare UPIN
OH0628101Medicare PIN