Healthcare Provider Details

I. General information

NPI: 1417192642
Provider Name (Legal Business Name): PARTNERS PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 W MARKET ST #200
FAIRLAWN OH
44333-4540
US

IV. Provider business mailing address

3600 W MARKET ST #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: DANIEL TAILLARD
Title or Position: DIRECTOR, FINANCE
Credential:
Phone: 330-344-6095