Provider Demographics
NPI:1578718821
Name:SOUZA, DMITRI (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DMITRI
Middle Name:
Last Name:SOUZA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:DMITRI
Other - Middle Name:
Other - Last Name:SOUZDALNITSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1900 23RD ST
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1404
Mailing Address - Country:US
Mailing Address - Phone:330-971-7246
Mailing Address - Fax:330-971-7256
Practice Address - Street 1:1900 23RD ST
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1404
Practice Address - Country:US
Practice Address - Phone:330-971-7246
Practice Address - Fax:330-971-7256
Is Sole Proprietor?:No
Enumeration Date:2008-11-27
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.096297207L00000X, 207R00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0052082Medicaid
OH0052082Medicaid