Provider Demographics
NPI:1720145899
Name:COMPREHENSIVE FAMILY PRACTICE
Entity Type:Organization
Organization Name:COMPREHENSIVE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT AND SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PRANAS
Authorized Official - Last Name:NEVERAUSKAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-726-1585
Mailing Address - Street 1:4805 SUDER AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43611-1800
Mailing Address - Country:US
Mailing Address - Phone:419-726-1585
Mailing Address - Fax:419-726-0381
Practice Address - Street 1:4805 SUDER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43611-1800
Practice Address - Country:US
Practice Address - Phone:419-726-1585
Practice Address - Fax:419-726-0381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006654207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty