Healthcare Provider Details

I. General information

NPI: 1558362020
Provider Name (Legal Business Name): TINA MARIE MARKS AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE TW 2-3
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE TW 2-3
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 330-888-4218
  • Fax: 330-888-4215
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA01478
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: