Organization
PORTAGE INTERNAL MEDICINE ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEAN J DEPERRO SR. DO (PHYSICAN)
(330) 346-0800
Entity
Organization
Contact information
Practice address
503 OVERLOOK DR, KENT, OH 44240-5824
(330) 645-6463
(330) 645-6462
Mailing address
PO BOX 45519, WESTLAKE, OH 44145-0519
(800) 514-4390
(440) 808-3675
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
34006535
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2192863
—
OH
01
—
DO7407
RAILROAD CARE
OH
Enumeration date
09/06/2007
Last updated
12/20/2023
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