Healthcare Provider Details

I. General information

NPI: 1053362236
Provider Name (Legal Business Name): ROCCO ANTHONY PETROZZI JR. D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 EUCLID AVE SUITE 101
CLEVELAND OH
44103-4014
US

IV. Provider business mailing address

1636 N SHORE DR
PAINESVILLE OH
44077-4679
US

V. Phone/Fax

Practice location:
  • Phone: 216-231-5612
  • Fax: 216-721-5534
Mailing address:
  • Phone: 440-290-5327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36.003393
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: