Unknown Individual – Family Medicine Physician, NPI 1417955808
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
4236, Secor Road, Deaveaux, Toledo, Lucas County, Ohio, 43623, United States
TOLEDO, OH 436234238
Phone: (419) 666-2560
Type: Mailing
1265, Dixie Highway, Rossford, Wood County, Ohio, 43460, United States
ROSSFORD, OH 434601405
Phone: (419) 666-2560
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 43623)
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