=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336329259
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARTNERS PHYSICIAN GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2007
-----------------------------------------------------
Last Update Date | 02/27/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 WABASH AVE
-----------------------------------------------------
City | AKRON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44307-2433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-344-7200
-----------------------------------------------------
Fax | 330-344-7290
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 WABASH AVE
-----------------------------------------------------
City | AKRON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44307-2433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-344-7200
-----------------------------------------------------
Fax | 330-344-7290
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF MEDICAL OFFICER
-----------------------------------------------------
Name | KENNETH J BRAMAN
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 330-665-8305
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------