Healthcare Provider Details

I. General information

NPI: 1710985163
Provider Name (Legal Business Name): JON DOMINIC OLIVERIO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 08/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1193 NORTON AVE SUITE D
NORTON OH
44203-9516
US

IV. Provider business mailing address

1193 NORTON AVE SUITE D
NORTON OH
44203-9516
US

V. Phone/Fax

Practice location:
  • Phone: 330-825-7878
  • Fax: 330-595-4729
Mailing address:
  • Phone: 330-825-7878
  • Fax: 330-595-4729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36-00-2891-0
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: