Healthcare Provider Details

I. General information

NPI: 1851543631
Provider Name (Legal Business Name): AMIT DIWAKAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 W. EXCHANGE ST SUITE 380
AKRON OH
44302
US

IV. Provider business mailing address

520 S. MAIN ST SUITE 2446A
AKRON OH
44311
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-6676
  • Fax: 330-434-3611
Mailing address:
  • Phone: 330-253-7415
  • Fax: 330-253-5260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number35112965
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35112965
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: