Healthcare Provider Details

I. General information

NPI: 1396759221
Provider Name (Legal Business Name): PARTNERS PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 W MARKET ST STE. 200
FAIRLAWN OH
44333-4540
US

IV. Provider business mailing address

3600 W MARKET ST STE. 200
FAIRLAWN OH
44333-4540
US

V. Phone/Fax

Practice location:
  • Phone: 330-666-2700
  • Fax: 330-666-0500
Mailing address:
  • Phone: 330-666-2700
  • Fax: 330-666-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateOH

VIII. Authorized Official

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