MEDICARE: DR. NEAL DAVID TISHMAN D.O.

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	207P00000X	Emergency Medicine Physician	34-00-4525	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912990706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEAL DAVID TISHMAN D.O.

Provider Business Mailing Address
First Line	:	2235 MAHONING RD
Second Line	:
City	:	LAKE MILTON
State	:	OH
Zip	:	44429-9562
Country	:	US
Telephone Number	:	724-699-8625
Fax Number	:

Provider Business Practice Location Address
First Line	:	2235 MAHONING RD
Second Line	:
City	:	LAKE MILTON
State	:	OH
Zip	:	44429-9562
Country	:	US
Telephone Number	:	724-699-8625
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	12/14/2012

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