Healthcare Provider Details

I. General information

NPI: 1568775054
Provider Name (Legal Business Name): PARTNERS PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 10/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4336 BRECKSVILLE RD
RICHFIELD OH
44286-9195
US

IV. Provider business mailing address

4336 BRECKSVILLE RD
RICHFIELD OH
44286-9195
US

V. Phone/Fax

Practice location:
  • Phone: 330-659-0641
  • Fax: 330-659-0649
Mailing address:
  • Phone: 330-659-0641
  • Fax: 330-659-0649

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 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