Provider Demographics
NPI:1811160401
Name:AKRON GERIATRIC, INC
Entity type:Organization
Organization Name:AKRON GERIATRIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BONG
Authorized Official - Middle Name:S
Authorized Official - Last Name:KAUH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-666-5713
Mailing Address - Street 1:111 STOW AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-2560
Mailing Address - Country:US
Mailing Address - Phone:330-564-2629
Mailing Address - Fax:330-546-7758
Practice Address - Street 1:4242 COBBLESTONE DR
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-2925
Practice Address - Country:US
Practice Address - Phone:330-666-5713
Practice Address - Fax:330-666-5657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.057848207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9374941Medicare PIN