Provider Demographics
NPI:1962875377
Name:TSAI, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:TSAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35264 SADDLE CRK
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-4908
Mailing Address - Country:US
Mailing Address - Phone:330-802-2721
Mailing Address - Fax:
Practice Address - Street 1:2999 PAYNE AVE
Practice Address - Street 2:#132
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-4400
Practice Address - Country:US
Practice Address - Phone:216-539-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2442474163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2442474Medicaid