Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 35.124464 | OH |
N | 207X00000X | Orthopaedic Surgeon | MT193836 | PA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 35.124464 | OH |
NPI | 1659522316 |
---|---|
Provider Name | Dr. Ronald Justin Mistovich |
First Address | Cleveland, OH 44109-1900 |
Second Address | Cleveland, OH 44109-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2008 |
Last Update Date | 30/11/2020 |