Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 35.133625 | OH |
N | 2081P2900X | Pain Medicine | 35.133625 | OH |
NPI | 1285053587 |
---|---|
Provider Name | Antimo Paul Gazzillo |
First Address | Cleveland, OH 44106-1716 |
Second Address | Cleveland, OH 44106-1716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2014 |
Last Update Date | 30/11/2020 |