Provider Demographics
NPI:1558554139
Name:FERRADINO, EVERETT E (DPM)
Entity Type:Individual
Prefix:DR
First Name:EVERETT
Middle Name:E
Last Name:FERRADINO
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 1:1050 ISAAC STREETS DR
Mailing Address - Street 2:SUITE 122
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3291
Mailing Address - Country:US
Mailing Address - Phone:419-693-4171
Mailing Address - Fax:419-693-6863
Practice Address - Street 1:1050 ISAAC STREETS DR
Practice Address - Street 2:SUITE 122
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3291
Practice Address - Country:US
Practice Address - Phone:419-693-4171
Practice Address - Fax:419-693-6863
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003491213ES0103X
MI5901002427213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
9508156OtherAETNA
05468OtherPARAMOUNT
OH2861390Medicaid
000000574866OtherANTHEM
05468OtherPARAMOUNT
000000574866OtherANTHEM
OH2861390Medicaid