Provider Demographics
NPI:1962513747
Name:DIAMOND FAMILY PRACTICE, LLC
Entity type:Organization
Organization Name:DIAMOND FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SOBOLEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-753-2400
Mailing Address - Street 1:87 CONSERVATORY DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-4291
Mailing Address - Country:US
Mailing Address - Phone:330-753-2400
Mailing Address - Fax:330-753-3878
Practice Address - Street 1:87 CONSERVATORY DR
Practice Address - Street 2:SUITE B
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-4291
Practice Address - Country:US
Practice Address - Phone:330-753-2400
Practice Address - Fax:330-753-3878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2267989Medicaid
OH2267989Medicaid
OH=========-00OtherBWC