Healthcare Provider Details

I. General information

NPI: 1659329076
Provider Name (Legal Business Name): ROBERT G NETZLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WABASH AVE #3500
AKRON OH
44307-2433
US

IV. Provider business mailing address

400 WABASH AVE #3500
AKRON OH
44307-2433
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-1400
  • Fax: 330-344-0112
Mailing address:
  • Phone: 330-344-1400
  • Fax: 330-344-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35-050271
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number35-050271
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: