Healthcare Provider Details

I. General information

NPI: 1881148328
Provider Name (Legal Business Name): AKSHAY DEOTARE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2016
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 ARCH ST SUMMA HEALTH SYSTEM/INTERNAL MEDICINE CENTER SUITE 1B
AKRON OH
44304-1423
US

IV. Provider business mailing address

55 ARCH ST SUMMA HEALTH SYSTEM/INTERNAL MEDICINE CENTER SUITE 1B
AKRON OH
44304-1423
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-3315
  • Fax:
Mailing address:
  • Phone: 330-375-3315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2020-00215
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: