Provider Demographics
NPI:1780677013
Name:TITKO, JERRY L (DPM)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:L
Last Name:TITKO
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 1:7344 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231
Mailing Address - Country:US
Mailing Address - Phone:513-729-4455
Mailing Address - Fax:513-728-4861
Practice Address - Street 1:7344 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231
Practice Address - Country:US
Practice Address - Phone:513-729-4455
Practice Address - Fax:513-728-4861
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1359213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH8810255Medicaid
T80298Medicare UPIN
OHTI0012445Medicare ID - Type Unspecified
OH8810255Medicaid