Provider Demographics
NPI:1174051320
Name:PROYA, JOSEPH MICHAEL
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:PROYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12963 NELSON LEDGE RD
Mailing Address - Street 2:
Mailing Address - City:GARRETTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44231-9627
Mailing Address - Country:US
Mailing Address - Phone:330-348-7411
Mailing Address - Fax:330-248-7224
Practice Address - Street 1:12963 NELSON LEDGE RD
Practice Address - Street 2:
Practice Address - City:GARRETTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44231-9627
Practice Address - Country:US
Practice Address - Phone:330-348-1741
Practice Address - Fax:330-248-7224
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH120469174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty