Unknown Individual – Gastroenterology Physician, NPI 1124023569

Unknown Individual is a healthcare provider. based in Canton, Ohio. specializing in Gastroenterology Physician. They hold a License No. 35042118W (OH). The NPI Number for Unknown Individual is 1124023569

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1124023569
Phone
(330) 305-2020
Address
4360 FULTON DR NW
Deactivation Date
3 July 2024
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 4360 FULTON DR NW

    STE B

    CANTON, OH 447182824

    Phone: (330) 305-2020

    Fax: (330) 305-9090

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 44718)

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Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?
In the U.S., Unknown Individual is identified by NPI 1124023569.
What happens when Unknown Individual's NPI is not active?
Public data lists Unknown Individual outside the active bucket for this identifier.
What services align with Unknown Individual's listing?
Unknown Individual's public classification highlights Gastroenterology Physician. Clinical services aligned with this taxonomy classification.
Can patients visit Unknown Individual in Canton, Ohio?
For routing, start with Canton, Ohio for Unknown Individual, then verify phone and hours locally.
What is the difference between NPI and a medical license?
An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.

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