Provider Demographics
NPI:1003418922
Name:PETERSON, TAMIR P
Entity Type:Individual
Prefix:
First Name:TAMIR
Middle Name:P
Last Name:PETERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 GLENDORA AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-1961
Mailing Address - Country:US
Mailing Address - Phone:330-462-8442
Mailing Address - Fax:
Practice Address - Street 1:696 GLENDORA AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-1961
Practice Address - Country:US
Practice Address - Phone:330-462-8442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker