Healthcare Provider Details

I. General information

NPI: 1528093473
Provider Name (Legal Business Name): SALVATORE PATRICK SIDOTI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6681 RIDGE RD SUITE 405
PARMA OH
44129-5705
US

IV. Provider business mailing address

6681 RIDGE ROAD SUITE 405
PARMA OH
44129-5705
US

V. Phone/Fax

Practice location:
  • Phone: 440-884-4114
  • Fax: 440-884-7661
Mailing address:
  • Phone: 440-884-4114
  • Fax: 440-884-7661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36.002376
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: