MEDICARE: JOHN NICK PATZAKIS DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	34004003	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093751448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN NICK PATZAKIS DO

Provider Business Mailing Address
First Line	:	5188 HICKORY DRIVE
Second Line	:
City	:	LYNDHURST
State	:	OH
Zip	:	44124
Country	:	US
Telephone Number	:	440-646-0755
Fax Number	:	440-995-5055

Provider Business Practice Location Address
First Line	:	99 NORTHLINE CIR
Second Line	:	SUITE 99
City	:	EUCLID
State	:	OH
Zip	:	44119-1482
Country	:	US
Telephone Number	:	440-646-0755
Fax Number	:	440-995-5055

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	07/08/2007

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