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General NPI Number Information
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NPI Number | 1093751448
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Entity Type | Individual
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Provider Name | JOHN NICK PATZAKIS DO
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Gender | Male
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 99 NORTHLINE CIR SUITE 99
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City | EUCLID
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State | OH
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Zip | 44119-1482
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Country | US
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Telephone | 440-646-0755
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Fax | 440-995-5055
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Provider Business Mailing Address
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Address Line | 5188 HICKORY DRIVE
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City | LYNDHURST
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State | OH
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Zip | 44124
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Country | US
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Telephone | 440-646-0755
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Fax | 440-995-5055
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 34004003
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License Number State | OH
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