Provider Demographics
NPI:1861567091
Name:OBSTETRICAL & GYNECOLOGICAL ASSOCIATES OF AKRON INC
Entity type:Organization
Organization Name:OBSTETRICAL & GYNECOLOGICAL ASSOCIATES OF AKRON INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:COUSINEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-668-6545
Mailing Address - Street 1:605 N CLEVELAND MASSILLON RD
Mailing Address - Street 2:STE A
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333
Mailing Address - Country:US
Mailing Address - Phone:330-668-6545
Mailing Address - Fax:330-668-2726
Practice Address - Street 1:605 N CLEVELAND MASSILLON RD
Practice Address - Street 2:STE A
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333
Practice Address - Country:US
Practice Address - Phone:330-668-6545
Practice Address - Fax:330-668-2726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35035038P207V00000X
OH35080285O207V00000X
OH34004947207V00000X
OH34006076C207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH034069Medicaid
OH034069Medicaid