Provider Demographics
NPI:1225050248
Name:OSSAKOW, STEVEN JAY (MD FACS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JAY
Last Name:OSSAKOW
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4912 HIGBEE AVENUE NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718
Mailing Address - Country:US
Mailing Address - Phone:330-492-2844
Mailing Address - Fax:330-492-0840
Practice Address - Street 1:4912 HIGBEE AVENUE NW
Practice Address - Street 2:SUITE 200
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718
Practice Address - Country:US
Practice Address - Phone:330-492-2844
Practice Address - Fax:330-492-0840
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35055075207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0665838Medicaid
80604621Medicare ID - Type Unspecified
OH0665838Medicaid