MEDICARE: DR. PAUL A PRYATEL D.P.M.

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	213E00000X	Podiatrist	OH 36-00-2370-P	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000216707	OTHER	OH	ANTHEM BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184673485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL A PRYATEL D.P.M.

Provider Business Mailing Address
First Line	:	448 LYNDEN DR
Second Line	:
City	:	HIGHLAND HTS
State	:	OH
Zip	:	44143-1565
Country	:	US
Telephone Number	:	440-684-9840
Fax Number	:	440-684-9840

Provider Business Practice Location Address
First Line	:	448 LYNDEN DR
Second Line	:
City	:	HIGHLAND HTS
State	:	OH
Zip	:	44143-1565
Country	:	US
Telephone Number	:	440-516-3776
Fax Number	:	440-516-3783

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

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	09/28/2010

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