Provider Demographics
NPI:1619965449
Name:PALUTSIS, ROGER S (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:S
Last Name:PALUTSIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S ARCH AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4202
Mailing Address - Country:US
Mailing Address - Phone:330-821-0201
Mailing Address - Fax:330-821-1924
Practice Address - Street 1:1401 S ARCH AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4202
Practice Address - Country:US
Practice Address - Phone:330-821-0201
Practice Address - Fax:330-821-1924
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063106207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0894493Medicaid
OH341089680OtherGREAT WEST HEALTH
OH733348OtherBUCKEYE HEALTH PLAN
OH341089680OtherAULTCARE
OH341089680023OtherCARESOURCE
OH4332880OtherAETNA
OH341089680OtherCIGNA
OH341089680OtherFIRST HEALTH
OH341089680OtherPPO NEXT
OHQ012010AOtherHOMETOWN HEALTH PLAN
OH000000126983OtherANTHEM
OH341089680OtherDIRECT CARE AMERICA
OH127480600OtherFEDERAL EMPLOYEES BWC
OH341089680OtherGREAT WEST HEALTH
OH341089680OtherFIRST HEALTH