Healthcare Provider Details

I. General information

NPI: 1184673485
Provider Name (Legal Business Name): PAUL A PRYATEL D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 LYNDEN DR
HIGHLAND HTS OH
44143-1565
US

IV. Provider business mailing address

448 LYNDEN DR
HIGHLAND HTS OH
44143-1565
US

V. Phone/Fax

Practice location:
  • Phone: 440-516-3776
  • Fax: 440-516-3783
Mailing address:
  • Phone: 440-684-9840
  • Fax: 440-684-9840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberOH 36-00-2370-P
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: