MEDICARE: PARTNERS PHYSICIAN GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RX0202X	Medical Oncology Physician		OH
2	207Q00000X	Family Medicine Physician		OH

General Provider Information

NPI Number	:	1275703506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARTNERS PHYSICIAN GROUP

Provider Business Mailing Address
First Line	:	3428 W MARKET ST
Second Line	:	#103
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-3339
Country	:	US
Telephone Number	:	330-344-3583
Fax Number	:	330-869-2074

Provider Business Practice Location Address
First Line	:	3300 GREENWICH RD
Second Line	:
City	:	NORTON
State	:	OH
Zip	:	44203-5714
Country	:	US
Telephone Number	:	330-825-7371
Fax Number	:	330-825-7473

Authorized Official
Title or Position	:	DIRECTOR,FINANCE BUSINESS OPERATION
Name	:	DANIEL TAILLARD
Credential	:
Telephone Number	:	330-344-6095

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	03/03/2008

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