Provider Demographics
NPI:1306861141
Name:SPISAK, DALIA M (MSN,RN,CPNP)
Entity Type:Individual
Prefix:
First Name:DALIA
Middle Name:M
Last Name:SPISAK
Suffix:
Gender:F
Credentials:MSN,RN,CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W BOWERY ST
Mailing Address - Street 2:SUITE 3500
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1069
Mailing Address - Country:US
Mailing Address - Phone:330-376-3332
Mailing Address - Fax:330-376-2980
Practice Address - Street 1:215 W BOWERY ST
Practice Address - Street 2:SUITE 3500
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1069
Practice Address - Country:US
Practice Address - Phone:330-376-3332
Practice Address - Fax:330-376-2980
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01659208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2390934Medicaid
OH2390934Medicaid