Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 34-004137 | OH |
NPI | 1225097249 |
---|---|
Provider Name | Dr. Zenos Anthony Vangelos |
First Address | Westlake, OH 44145-2398 |
Second Address | Westlake, OH 44145-2398 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2006 |
Last Update Date | 08/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0689367 | (05) | OH |
E00752 | (02) | OH |
P00381218 | RR MEDICARE (01) | OH |