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General NPI Number Information
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NPI Number | 1184624934
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Entity Type | Individual
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Provider Name | TATIANA MASYK MD
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Gender | Female
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Dates
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Enumeration Date | 07/22/2005
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Last Update Date | 08/04/2023
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Provider Practice Location Address
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Address Line | 6480 ROCKSIDE WOODS BLVD S STE 330
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City | INDEPENDENCE
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State | OH
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Zip | 44131-2222
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Country | US
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Telephone | 567-316-6755
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Fax | 216-238-9526
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Provider Business Mailing Address
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Address Line | 5705 SUN VALLEY BLVD
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City | SYLVANIA
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State | OH
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Zip | 43560-3745
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Country | US
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Telephone | 517-403-6857
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35.072419
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301069338
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License Number State | MI
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