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General NPI Number Information
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NPI Number | 1124067160
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Entity Type | Organization
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Legal Business Name | PARTNERS PHYSICIAN GROUP
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 02/13/2014
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Provider Practice Location Address
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Address Line | 225 ELYRIA ST
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City | LODI
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State | OH
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Zip | 44254-1031
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Country | US
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Telephone | 330-344-3583
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Fax |
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Provider Business Mailing Address
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Address Line | 225 ELYRIA ST
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City | LODI
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State | OH
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Zip | 44254-1031
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER, PPG
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Name | KENNETH BRAMAN
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Credential | MD
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Telephone | 330-665-8302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number |
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | OH
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