Jerome M Privitera Dpm, INC.
Podiatrist, Foot & Ankle Surgery in Mentor, OH. Organization (NPI-2).
NPI number1700969102
StatusActive
Last updated in NPPESOct 15, 2012
Details
- NPI
- 1700969102
- Entity type
- Organization (NPI-2)
- Legal business name
- Jerome M Privitera Dpm, INC.
- Organization subpart
- No
- Enumeration date
- Oct 23, 2006
- Last updated
- Oct 15, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 213ES0103X | Podiatrist, Foot & Ankle Surgery | OH002454 | OH | Yes |
| 213EP1101X | Podiatrist, Primary Podiatric Medicine | OH001535 | OH |
Practice location
9485 Mentor AveSuite 200
Mentor, OH 44060-8723
Phone 440-205-5878 · Fax 440-205-5875
Mailing address
9485 Mentor AveSuite 200
Mentor, OH 44060-8723
Phone 440-205-5878 · Fax 440-205-5875
Authorized official
Jerome M Privitera
Owner
4402055878
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