Provider Demographics
NPI:1306954987
Name:MIDURA, TIMOTHY J (PA C)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:J
Last Name:MIDURA
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10600COAL BANK RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44645
Mailing Address - Country:US
Mailing Address - Phone:330-855-2065
Mailing Address - Fax:
Practice Address - Street 1:566 EAST ROBINSON AVE
Practice Address - Street 2:STE 400
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203
Practice Address - Country:US
Practice Address - Phone:330-753-1015
Practice Address - Fax:330-753-3103
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50000968363AM0700X
OH50.000968207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P74317Medicare UPIN
OHPA20075Medicare PIN
M1PA20072Medicare ID - Type Unspecified