Provider Demographics
NPI:1427019678
Name:MIOTTO, PAUL VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:VICTOR
Last Name:MIOTTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:39000 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-2742
Mailing Address - Country:US
Mailing Address - Phone:440-329-7490
Mailing Address - Fax:440-329-7492
Practice Address - Street 1:39000 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-2742
Practice Address - Country:US
Practice Address - Phone:440-329-7490
Practice Address - Fax:440-329-7492
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-061718207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000339416OtherANTHEM
OH0114094Medicaid
OH26420000OtherDEPT OF LABOR
OH264200000OtherFEDERAL BLACK LUNG
OH6600162OtherUNITED HEALTHCARE
OH80507OtherQUALCHOICE
OH341425870042OtherMEDICAL MUTUAL OF OHIO
OH000000339416OtherANTHEM
OH264200000OtherFEDERAL BLACK LUNG
OH26420000OtherDEPT OF LABOR