Provider Demographics
NPI:1386026474
Name:KRETCH, DAVID (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:KRETCH
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 1:2880 PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3209
Mailing Address - Country:US
Mailing Address - Phone:440-333-5888
Mailing Address - Fax:440-333-6766
Practice Address - Street 1:2880 PLYMOUTH AVE
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116
Practice Address - Country:US
Practice Address - Phone:440-333-5888
Practice Address - Fax:440-333-6766
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL135000883213ES0103X
OH36003922213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005780Medicaid
OH0361281Medicaid