Provider Demographics
NPI:1881604817
Name:FROMM, MITCHEL L (MD)
Entity type:Individual
Prefix:
First Name:MITCHEL
Middle Name:L
Last Name:FROMM
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 1:122 N HAYDEN PKWY
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-3152
Mailing Address - Country:US
Mailing Address - Phone:330-650-6073
Mailing Address - Fax:
Practice Address - Street 1:1 AKRON GENERAL AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2432
Practice Address - Country:US
Practice Address - Phone:330-384-6448
Practice Address - Fax:330-344-6512
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0536422085R0001X
OH35.0536422085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0630991Medicaid
OH4104041Medicare ID - Type Unspecified
OH0630991Medicaid