Healthcare Provider Details

I. General information

NPI: 1548668247
Provider Name (Legal Business Name): MICHAEL EDWARD PUTINSKI PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TUSCARAWAS ST W STE 200
CANTON OH
44702-2044
US

IV. Provider business mailing address

400 TUSCARAWAS ST W STE 200
CANTON OH
44702-2044
US

V. Phone/Fax

Practice location:
  • Phone: 330-438-2400
  • Fax:
Mailing address:
  • Phone: 330-438-2400
  • Fax: 330-588-2216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN.360431
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: