Healthcare Provider Details

I. General information

NPI: 1578772893
Provider Name (Legal Business Name): SERGEY A VITEBSKIY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 W EXCHANGE ST #225
AKRON OH
44302-1704
US

IV. Provider business mailing address

224 W EXCHANGE ST #225
AKRON OH
44302-1704
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-4377
  • Fax: 330-761-2492
Mailing address:
  • Phone: 330-344-4377
  • Fax: 330-761-2492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.085221
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number35-085221
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: