Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 36.003732 | OH |
Y | 213ES0103X | Foot & Ankle Surgery | 36.003732 | OH |
NPI | 1306104724 |
---|---|
Provider Name | Dr. John Robert Taddeo |
First Address | Parma, OH 44129-2633 |
Second Address | Parma, OH 44129-2633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2012 |
Last Update Date | 20/07/2015 |