=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043410780
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH ANGELO TRUNZO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2007
-----------------------------------------------------
Last Update Date | 08/21/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29099 HEALTH CAMPUS DR BLDG 3
-----------------------------------------------------
City | WESTLAKE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44145-5200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-827-5755
-----------------------------------------------------
Fax | 440-827-5344
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24701 EUCLID AVE THIRD FLOOR BILLING SERVICES
-----------------------------------------------------
City | EUCLID
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44117-1714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-827-5755
-----------------------------------------------------
Fax | 440-827-5344
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 35.090675
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------