Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 35.089900 | OH |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 35089900 | OH |
NPI | 1053530311 |
---|---|
Provider Name | Dr. Ian Martin Gradisar |
First Address | Akron, OH 44333-8320 |
Second Address | Akron, OH 44333-8320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 18/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2965206 | (05) | OH |