Healthcare Provider Details

I. General information

NPI: 1144336470
Provider Name (Legal Business Name): WILLIAM J PETRAIUOLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36060 EUCLID AVE SUITE 204
WILLOUGHBY OH
44094
US

IV. Provider business mailing address

PO BOX 714328
COLUMBUS OH
43271-4328
US

V. Phone/Fax

Practice location:
  • Phone: 440-602-6553
  • Fax: 440-602-6566
Mailing address:
  • Phone: 800-354-1985
  • Fax: 440-350-4938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35061722
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: