Healthcare Provider Details

I. General information

NPI: 1144401464
Provider Name (Legal Business Name): PARTNERS PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AKRON GENERAL AVE
AKRON OH
44307-2432
US

IV. Provider business mailing address

1 AKRON GENERAL AVE
AKRON OH
44307-2432
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-1400
  • Fax: 330-344-0112
Mailing address:
  • Phone: 330-344-1400
  • Fax: 330-344-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: KENNETH BRAMAN
Title or Position: CHIEF MEDICAL OFFICER
Credential: DO
Phone: 330-665-8305