Healthcare Provider Details

I. General information

NPI: 1033324017
Provider Name (Legal Business Name): TAMIKA PATILLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3443 MEDINA RD SUITE 115
MEDINA OH
44256-5360
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 330-764-3457
  • Fax: 330-764-3464
Mailing address:
  • Phone: 330-764-3457
  • Fax: 330-764-3464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34.093202
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: