Basic Information
| Provider Information | |||||||||
| NPI: | 1851340822 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATRIUM MEDICAL GROUP, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6559 WILSON MILLS ROAD | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | MAYFIELD VILLAGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441433433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4404491540 | ||||||||
| FaxNumber: | 4404602833 | ||||||||
| Practice Location | |||||||||
| Address1: | 6559 WILSON MILLS RD | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | MAYFIELD VILLAGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441433433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4404491540 | ||||||||
| FaxNumber: | 4404602833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2006 | ||||||||
| LastUpdateDate: | 06/03/2014 | ||||||||
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| AuthorizedOfficialLastName: | MUKUNDA | ||||||||
| AuthorizedOfficialFirstName: | BEEJADI | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4404491540 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.