MEDICARE: DR. JEAN S. CHOY ZANNONI M.D.

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	207Q00000X	Family Medicine Physician	35-049714	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
2	34139669400	OTHER		BUREAU OF WORKMAN'S COMP

General Provider Information

NPI Number	:	1477617595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN S. CHOY ZANNONI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 29302
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44129-0302
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4732 PEARL RD
Second Line	:	STE 1
City	:	CLEVELAND
State	:	OH
Zip	:	44109-5106
Country	:	US
Telephone Number	:	216-741-2616
Fax Number	:	216-741-4377

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

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	01/23/2008

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