Healthcare Provider Details

I. General information

NPI: 1346284890
Provider Name (Legal Business Name): BRIAN S PUTKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32800 LORAIN RD STE 2300
NORTH RIDGEVILLE OH
44039-3430
US

IV. Provider business mailing address

6000 W CREEK RD SUITE 10
INDEPENDENCE OH
44131-2182
US

V. Phone/Fax

Practice location:
  • Phone: 440-506-5500
  • Fax:
Mailing address:
  • Phone: 800-223-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-082853
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: