Healthcare Provider Details

I. General information

NPI: 1306103270
Provider Name (Legal Business Name): PARTNERS PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2012
Last Update Date: 04/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 MEDINA RD #201
AKRON OH
44333-2483
US

IV. Provider business mailing address

4125 MEDINA RD #201
AKRON OH
44333-2483
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-4263
  • Fax: 330-945-3187
Mailing address:
  • Phone: 330-344-4263
  • Fax: 330-945-3187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: DANIEL TAILLARD
Title or Position: VP, FINANCE
Credential:
Phone: 330-344-6095