MEDICARE: JAMES REVELAS, 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	36-00-2443R	OH

General Provider Information

NPI Number	:	1790965176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES REVELAS, D.P.M.

Provider Business Mailing Address
First Line	:	64 EXECUTIVE DRIVE
Second Line	:
City	:	NORWALK
State	:	OH
Zip	:	44857
Country	:	US
Telephone Number	:	419-663-3338
Fax Number	:	419-668-4731

Provider Business Practice Location Address
First Line	:	64 EXECUTIVE DR
Second Line	:
City	:	NORWALK
State	:	OH
Zip	:	44857-9568
Country	:	US
Telephone Number	:	419-663-3338
Fax Number	:	419-668-4731

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES REVELAS
Credential	:	D.P.M.
Telephone Number	:	419-663-3338

Provider Enumeration Date	:	11/14/2007
Last Update Date	:	04/23/2008

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