Provider Demographics
NPI:1407118565
Name:CVETANOVICH, GREGORY LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:LOUIS
Last Name:CVETANOVICH
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 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-3600
Mailing Address - Fax:614-293-2910
Practice Address - Street 1:2835 FRED TAYLOR DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43202
Practice Address - Country:US
Practice Address - Phone:614-293-3600
Practice Address - Fax:614-293-2910
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35133051207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0308907Medicaid