Healthcare Provider Details

I. General information

NPI: 1831362755
Provider Name (Legal Business Name): PARTNERS PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALLEN RD #140
STOW OH
44224-1070
US

IV. Provider business mailing address

4302 ALLEN RD #140
STOW OH
44224-1070
US

V. Phone/Fax

Practice location:
  • Phone: 330-665-8270
  • Fax: 330-344-1004
Mailing address:
  • Phone: 330-665-8270
  • Fax: 330-344-1004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateOH

VIII. Authorized Official

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