Provider Demographics
NPI:1659365419
Name:CERVETTI, RONALD G (DPM)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:G
Last Name:CERVETTI
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 1:4508 CHADWICK RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-7958
Mailing Address - Country:US
Mailing Address - Phone:319-277-4508
Mailing Address - Fax:319-277-8908
Practice Address - Street 1:4508 CHADWICK RD
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-7958
Practice Address - Country:US
Practice Address - Phone:319-277-4508
Practice Address - Fax:319-277-8908
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00348213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0150169Medicaid
IA0150169Medicaid
IAT00904Medicare UPIN
IA15016Medicare PIN