Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 35-05-8009 | OH |
Y | 207RP1001X | Pulmonary Disease | 35-05-8009 | OH |
NPI | 1083602262 |
---|---|
Provider Name | Paul Terry Tsivitse |
First Address | Akron, OH 44304-1619 |
Second Address | Akron, OH 44304-1429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 04/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0495067 | (05) | OH |
F40160 | (02) |