Organization
MKT MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MITHILESH K TAMIRISA MD (SOLE MEMBER)
(419) 410-4898
Entity
Organization
Contact information
Practice address
516 RIVERSIDE DR, ROSSFORD, OH 43460-1055
(419) 410-4898
Mailing address
516 RIVERSIDE DR, ROSSFORD, OH 43460-1055
(419) 410-4898
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
03/11/2020
Last updated
03/11/2020
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