Provider Demographics
NPI:1669448684
Name:BACANI, ROBERTO ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:ANTONIO
Last Name:BACANI
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 1:3685 STUTZ DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9155
Mailing Address - Country:US
Mailing Address - Phone:330-259-0440
Mailing Address - Fax:330-259-0441
Practice Address - Street 1:3685 STUTZ DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9155
Practice Address - Country:US
Practice Address - Phone:330-259-0440
Practice Address - Fax:330-259-0441
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35031967207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0137140Medicaid
OHC00805Medicare UPIN
OH0151365Medicare ID - Type Unspecified
OHBA0151365Medicare PIN