Healthcare Provider Details

I. General information

NPI: 1023301025
Provider Name (Legal Business Name): PARTNERS PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 MEDINA RD #215
AKRON OH
44333-2483
US

IV. Provider business mailing address

4125 MEDINA RD #215
AKRON OH
44333-2483
US

V. Phone/Fax

Practice location:
  • Phone: 330-665-8143
  • Fax: 330-668-1289
Mailing address:
  • Phone: 330-665-8143
  • Fax: 330-668-1289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number35-050322
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-006963
License Number StateOH

VIII. Authorized Official

Name: DANIEL TAILLARD
Title or Position: DIRECTOR, FINANCE & OPERATIONS
Credential:
Phone: 330-344-6095