Provider Demographics
NPI:1508841172
Name:PARENTEAU, GARY LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:LOUIS
Last Name:PARENTEAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:730 W MARKET ST STE 2K
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4602
Mailing Address - Country:US
Mailing Address - Phone:419-996-4011
Mailing Address - Fax:419-996-4012
Practice Address - Street 1:730 W MARKET ST STE 2K
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4602
Practice Address - Country:US
Practice Address - Phone:419-996-4011
Practice Address - Fax:419-996-4012
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071085P208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0316876Medicaid
OHG39935Medicare UPIN
OH4177952Medicare PIN