Provider Demographics
NPI:1033376892
Name:PARTNERS PHYSICIAN GROUP
Entity Type:Organization
Organization Name:PARTNERS PHYSICIAN GROUP
Other - Org Name:AKRON INTERNAL MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-344-6095
Mailing Address - Street 1:3428 W MARKET ST
Mailing Address - Street 2:STE 103
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3339
Mailing Address - Country:US
Mailing Address - Phone:330-344-3583
Mailing Address - Fax:330-869-2074
Practice Address - Street 1:1755 W MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7040
Practice Address - Country:US
Practice Address - Phone:330-836-2828
Practice Address - Fax:330-836-0959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1760534796OtherNPI NUMBER KLEIN
OH0446374OtherMEDICARE IND NUMBER KLEIN
OH1407876220OtherNPI NUMBER MALIK
OH1841239274OtherMEDICARE NPI GROUP NUMBER
OH4028683OtherMEDICARE IND NUMBER MALIK
OH9338635OtherMEDICARE GROUP NUMBER