Provider Demographics
NPI:1376544148
Name:CERNIS, VICTOR S (DPM)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:S
Last Name:CERNIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8028 CLAUDE CT
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-1095
Mailing Address - Country:US
Mailing Address - Phone:419-885-3339
Mailing Address - Fax:419-885-3339
Practice Address - Street 1:1614 S BYRNE RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-3403
Practice Address - Country:US
Practice Address - Phone:419-381-1815
Practice Address - Fax:419-381-1815
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002459213ES0131X
MI1135213ES0131X
FL1568213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0686002Medicaid
OHT71136Medicare UPIN
OH0686002Medicaid