Healthcare Provider Details

I. General information

NPI: 1548698368
Provider Name (Legal Business Name): DR BARBARA LYNN PETKOVIC DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2013
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10631 SHERWOOD TRL
NORTH ROYALTON OH
44133-1979
US

IV. Provider business mailing address

PO BOX 33501
NORTH ROYALTON OH
44133-0501
US

V. Phone/Fax

Practice location:
  • Phone: 440-885-2130
  • Fax: 440-848-8406
Mailing address:
  • Phone: 440-885-2130
  • Fax: 440-848-8406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateOH

VIII. Authorized Official

Name: DR. BARBARA LYNN PETKOVIC
Title or Position: OWNER
Credential: D.P.M.
Phone: 440-885-2130