Individual
MITHILESH TAMIRISA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
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
(419) 318-4395
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35050201
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0628888
—
OH
Enumeration date
09/07/2005
Last updated
03/17/2020
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