Healthcare Provider Details

I. General information

NPI: 1831556851
Provider Name (Legal Business Name): PARTNERS PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4494 STATE ROUTE 43
KENT OH
44240-8206
US

IV. Provider business mailing address

4494 STATE ROUTE 43
KENT OH
44240-8206
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-1600
  • Fax:
Mailing address:
  • Phone: 330-344-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateOH

VIII. Authorized Official

Name: KENNETH J BRAMAN
Title or Position: CHIEF MEDICAL OFFICER
Credential: DO
Phone: 330-665-8302