Healthcare Provider Details

I. General information

NPI: 1164814414
Provider Name (Legal Business Name): PARTNERS PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 MEDINA RD
AKRON OH
44333-2483
US

IV. Provider business mailing address

4125 MEDINA RD
AKRON OH
44333-2483
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-4287
  • Fax:
Mailing address:
  • Phone: 330-344-4287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number StateOH

VIII. Authorized Official

Name: CAROL ICSMAN
Title or Position: VP, MANAGED CARE DEPT.
Credential:
Phone: 330-344-1657