Provider Demographics
NPI:1114905338
Name:RAKOLTA, GEORGE GABRIEL (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:GABRIEL
Last Name:RAKOLTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4533 GRANVILLE CT
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1606
Mailing Address - Country:US
Mailing Address - Phone:419-841-7573
Mailing Address - Fax:
Practice Address - Street 1:4533 GRANVILLE CT
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1606
Practice Address - Country:US
Practice Address - Phone:419-841-7573
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.037946207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery