MEDICARE: ROMAN PETROFF 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	207R00000X	Internal Medicine Physician	35047914	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110216615	OTHER	OH	RAILROAD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477568863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROMAN PETROFF MD

Provider Business Mailing Address
First Line	:	730 SOM CENTER RD STE 230
Second Line	:
City	:	MAYFIELD
State	:	OH
Zip	:	44143-2362
Country	:	US
Telephone Number	:	440-461-6477
Fax Number	:	440-461-1017

Provider Business Practice Location Address
First Line	:	730 SOM CENTER RD STE 230
Second Line	:
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-2362
Country	:	US
Telephone Number	:	440-461-6477
Fax Number	:	440-461-1017

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	01/15/2021

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Directions to “ ROMAN PETROFF MD” Practice Location

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