Healthcare Provider Details

I. General information

NPI: 1386607240
Provider Name (Legal Business Name): ALLISON M TJAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON M KOCSIS PA-C

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 LORAIN AVE
CLEVELAND OH
44111-5612
US

IV. Provider business mailing address

PO BOX 74953
CLEVELAND OH
44194-1036
US

V. Phone/Fax

Practice location:
  • Phone: 216-476-7310
  • Fax:
Mailing address:
  • Phone: 216-476-7310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50001848
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: