Provider Demographics
NPI:1831506369
Name:COMPREHENSIVE SURGICAL GROUP OF NORTHEAST OHIO LTD
Entity type:Organization
Organization Name:COMPREHENSIVE SURGICAL GROUP OF NORTHEAST OHIO LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-707-0771
Mailing Address - Street 1:7645 MARKET ST.
Mailing Address - Street 2:STE# 200
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5980
Mailing Address - Country:US
Mailing Address - Phone:330-707-0771
Mailing Address - Fax:330-707-0618
Practice Address - Street 1:7645 MARKET ST
Practice Address - Street 2:200
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5980
Practice Address - Country:US
Practice Address - Phone:330-707-0771
Practice Address - Fax:330-707-0618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty