Provider Demographics
NPI:1558369330
Name:PANIGUTTI, MARK ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:PANIGUTTI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7255 OLD OAK BLVD
Mailing Address - Street 2:C405
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3329
Mailing Address - Country:US
Mailing Address - Phone:440-816-5380
Mailing Address - Fax:440-816-5398
Practice Address - Street 1:7255 OLD OAK BLVD
Practice Address - Street 2:C405
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3329
Practice Address - Country:US
Practice Address - Phone:440-816-5380
Practice Address - Fax:440-816-5398
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35-067775207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2115384Medicaid
OHPA4065841Medicare ID - Type Unspecified
OHG97348Medicare UPIN