Provider Demographics
NPI:1831607928
Name:MATTHEW J DOERSCHUK
Entity type:Organization
Organization Name:MATTHEW J DOERSCHUK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOERSCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-268-7502
Mailing Address - Street 1:9526 FREEMAN RD
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-9759
Mailing Address - Country:US
Mailing Address - Phone:330-268-7502
Mailing Address - Fax:
Practice Address - Street 1:9526 FREEMAN RD
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-9759
Practice Address - Country:US
Practice Address - Phone:330-268-7502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-11
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No3416L0300XTransportation ServicesAmbulanceLand Transport