Provider Demographics
NPI:1063449353
Name:TUFFUOR, EMMANUEL O (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:O
Last Name:TUFFUOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 WARRENSVILLE CENTER RD STE 250
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7000
Mailing Address - Country:US
Mailing Address - Phone:216-491-1178
Mailing Address - Fax:216-491-8486
Practice Address - Street 1:4200 WARRENSVILLE CENTER RD STE 250
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-7000
Practice Address - Country:US
Practice Address - Phone:216-491-1178
Practice Address - Fax:216-491-8486
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-45260207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0438066Medicaid
OH0487786Medicare PIN
OH0438066Medicaid
OH0487781Medicare PIN