MEDICARE: DR. PAUL VICTOR MIOTTO MD

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	207QS0010X	Sports Medicine (Family Medicine) Physician	35-061718	OH
2	207Q00000X	Family Medicine Physician	35-061718	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000339416	OTHER	OH	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	26420000	OTHER	OH	DEPT OF LABOR
4	264200000	OTHER	OH	FEDERAL BLACK LUNG
5	6600162	OTHER	OH	UNITED HEALTHCARE
6	80507	OTHER	OH	QUALCHOICE
7	341425870042	OTHER	OH	MEDICAL MUTUAL OF OHIO

General Provider Information

NPI Number	:	1427019678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL VICTOR MIOTTO MD

Provider Business Mailing Address
First Line	:	39000 CENTER RIDGE RD
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-2742
Country	:	US
Telephone Number	:	440-329-7490
Fax Number	:	440-329-7492

Provider Business Practice Location Address
First Line	:	39000 CENTER RIDGE RD
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-2742
Country	:	US
Telephone Number	:	440-329-7490
Fax Number	:	440-329-7492

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	04/30/2019

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Directions to “ DR. PAUL VICTOR MIOTTO MD” Practice Location

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