Provider Demographics
NPI:1063736726
Name:MICHAEL TIRMONIA, DO, INC
Entity type:Organization
Organization Name:MICHAEL TIRMONIA, DO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:VIRGIL
Authorized Official - Last Name:TIRMONIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-489-1428
Mailing Address - Street 1:1330 MERCY DR NW STE 324
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2625
Mailing Address - Country:US
Mailing Address - Phone:330-489-1428
Mailing Address - Fax:330-430-2761
Practice Address - Street 1:1330 MERCY DR NW STE 324
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2625
Practice Address - Country:US
Practice Address - Phone:330-489-1428
Practice Address - Fax:330-430-2761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-6209-T261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0820561OtherMEDICARE IDENTIFICATION NUMBER
OH36D0917207OtherCLIA NUMBER
OH36D0917207OtherCLIA NUMBER