Provider Demographics
NPI:1407054885
Name:CUFFARI, JOHN MARIO (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MARIO
Last Name:CUFFARI
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 1:21992 LORAIN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-3333
Mailing Address - Country:US
Mailing Address - Phone:440-333-7300
Mailing Address - Fax:440-333-7308
Practice Address - Street 1:21992 LORAIN RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-3333
Practice Address - Country:US
Practice Address - Phone:440-333-7300
Practice Address - Fax:440-333-7308
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002362C213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000251058OtherANTHEM
OH0671009Medicaid
OH0671009Medicaid
OHCU0601457Medicare PIN