| Bruce Willner Do Llc | |
|
3622 Belmont Ave Ste 18 Youngstown OH 44505-1444 | |
| (330) 759-8050 | |
| (330) 759-1246 |
| Full Name | Bruce Willner Do Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3622 Belmont Ave Ste 18, Youngstown, Ohio |
| Authorized Official Name and Position | Bruce Willner (OWNER/PRESIDENT) |
| Authorized Official Contact | 3307598050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bruce Willner Do Llc 3622 Belmont Ave Ste 18 Youngstown OH 44505-1444 Ph: (330) 759-8050 | Bruce Willner Do Llc 3622 Belmont Ave Ste 18 Youngstown OH 44505-1444 Ph: (330) 759-8050 |
| NPI Number | 1730664558 |
|---|---|
| Provider Enumeration Date | 09/27/2018 |
| Last Update Date | 09/27/2018 |
| Medicare PECOS PAC ID | 4486991916 |
|---|---|
| Medicare Enrollment ID | O20190122003324 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730664558 | NPI | - | NPPES |
| 34-004681 | Other | OH | LIC # |
| 0791899 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Bruce Daniel Willner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609853076 PECOS PAC ID: 4880886670 Enrollment ID: I20101012000965 |
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