Most Relevant Information
Provider Data
| NPI Number: | 1003511098 |
| Provider Name: | ANDRE WILLIS LDO/NCLE |
| Entity Type: | Individual |
| Taxonomy Code: | 156FX1800X |
| Specialty: | Technician/Technologist |
| License Number: | OP.006709-SC |
Most Important Dates
| Enumeration Date: | 03/31/2023 |
| Last Updated: | 03/31/2023 |
Provider Practice Location
250 TALLMADGE RD
KENT
OH
442407204
Practice Location Phone/Fax
| Phone: | 3306733516 |
| Fax: | 3306733538 |
Provider Mailing Location
250 TALLMADGE RD
KENT
OH
442407204
Provider Mailing Phone/Fax
| Phone: | 3306733516 |
| Fax: | 3306733538 |