Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 34004783 | OH |
NPI | 1003802141 |
---|---|
Provider Name | Timothy Plank |
First Address | Middleburg Heights, OH 44130-6300 |
Second Address | Elyria, OH 44035 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 17/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0860564 | (05) | OH |
F02152 | (02) | OH |