Provider Demographics
NPI:1063563708
Name:MARKULIN, LOUIS MICHAEL (LMT)
Entity type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:MICHAEL
Last Name:MARKULIN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 625
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-0625
Mailing Address - Country:US
Mailing Address - Phone:330-286-3414
Mailing Address - Fax:330-286-5084
Practice Address - Street 1:565 E MAIN ST
Practice Address - Street 2:SAUITE 210
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-1598
Practice Address - Country:US
Practice Address - Phone:330-286-3414
Practice Address - Fax:330-286-5084
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000006109332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2402797Medicaid
PA4614410001Medicare ID - Type Unspecified