Provider Demographics
NPI:1275583114
Name:ZETZER, STUART I (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:I
Last Name:ZETZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:614 W SUPERIOR AVE STE 804
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-1306
Mailing Address - Country:US
Mailing Address - Phone:216-633-7576
Mailing Address - Fax:216-771-9455
Practice Address - Street 1:2285 BENDEN DRIVE
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691
Practice Address - Country:US
Practice Address - Phone:330-264-9029
Practice Address - Fax:330-263-7251
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350351742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0916950Medicaid
OH0916950Medicaid
0416693Medicare PIN