Healthcare Provider Details

I. General information

NPI: 1669665253
Provider Name (Legal Business Name): ADRIENNE LORETZ D.P.M
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3461 WARRENSVILLE CENTER RD SUITE 201
SHAKER HEIGHTS OH
44122-5260
US

IV. Provider business mailing address

3461 WARRENSVILLE CENTER RD SUITE 201
SHAKER HEIGHTS OH
44122-5260
US

V. Phone/Fax

Practice location:
  • Phone: 216-561-3303
  • Fax: 216-561-7790
Mailing address:
  • Phone: 216-561-3303
  • Fax: 216-561-7790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36003520
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36.003520
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: