Provider Demographics
NPI:1538349345
Name:FORMOSO, JAMES STEVEN (BC-HIS)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:STEVEN
Last Name:FORMOSO
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7985 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-1201
Mailing Address - Country:US
Mailing Address - Phone:440-526-3700
Mailing Address - Fax:440-526-3701
Practice Address - Street 1:7985 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-1201
Practice Address - Country:US
Practice Address - Phone:440-526-3700
Practice Address - Fax:440-526-3701
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2769174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist