Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 34004003 | OH |
NPI | 1093751448 |
---|---|
Provider Name | John Nick Patzakis |
First Address | Lyndhurst, OH 44124 |
Second Address | Euclid, OH 44119-1482 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0792227 | (05) | OH |
A16667 | (02) |