Provider Demographics
NPI:1811328065
Name:BOW TIE MEDICAL OHIO, LLC
Entity type:Organization
Organization Name:BOW TIE MEDICAL OHIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:FIROUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:DANESHGARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-283-8663
Mailing Address - Street 1:7750 TOWN CENTRE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-4040
Mailing Address - Country:US
Mailing Address - Phone:877-283-8863
Mailing Address - Fax:213-784-5670
Practice Address - Street 1:7500 TOWN CENTRE DR STE 200
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-4029
Practice Address - Country:US
Practice Address - Phone:877-283-8863
Practice Address - Fax:213-784-5670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty