MKT MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

MKT MD

Practice address

516 Riverside Dr
Rossford, OH 43460-1055

Phone

(419) 410-4898

NPI assigned

Mar 11, 2020

Last updated

Mar 11, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mithilesh K Tamirisa, MDNPI 1861486714

Title

Sole Member

Phone

(419) 410-4898

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mithilesh Tamirisa, MD

  • Internal Medicine Physician
  • Rossford, OH
  • NPI 1861486714
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583884800000",
    "number": "1700411634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 RIVERSIDE DR",
            "city": "ROSSFORD",
            "state": "OH",
            "postal_code": "434601055",
            "telephone_number": "419-410-4898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 RIVERSIDE DR",
            "city": "ROSSFORD",
            "state": "OH",
            "postal_code": "434601055",
            "telephone_number": "419-410-4898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MKT MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-11",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A",
        "authorized_official_last_name": "TAMIRISA",
        "authorized_official_first_name": "MITHILESH",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "419-410-4898",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mercy Health-St Charles Hospital LLC (Benjamin A White, DO)
• Kari Messenger
• Jenna Michniewicz
• Amyee Miller, CNP
• Jordan Mitri
• Tyler Morehart, DMD
• Brandie M Mosley
• Edward Mothershed
• Sara Elizabeth Mowery, R.PH.
• Vickie Ella Myhand

• Internal Medicine Physician in Rossford, OH
• Providers in Rossford, OH by specialty
• Internal Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.