Provider Demographics
NPI:1487672622
Name:RITZ, GARY (DPM)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:RITZ
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 1:12896 WOODSIDE DR S
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-3049
Mailing Address - Country:US
Mailing Address - Phone:440-729-6316
Mailing Address - Fax:440-729-3613
Practice Address - Street 1:12896 WOODSIDE DR S
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026
Practice Address - Country:US
Practice Address - Phone:440-666-6383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-002469213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0700521Medicaid
OHT64108Medicare UPIN
OH4137761Medicare ID - Type Unspecified