Provider Demographics
NPI:1184673485
Name:PRYATEL, PAUL A (DPM)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:PRYATEL
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 1:448 LYNDEN DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1565
Mailing Address - Country:US
Mailing Address - Phone:440-684-9840
Mailing Address - Fax:440-684-9840
Practice Address - Street 1:448 LYNDEN DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44143-1565
Practice Address - Country:US
Practice Address - Phone:440-516-3776
Practice Address - Fax:440-516-3783
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH 36-00-2370-P213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000216707OtherANTHEM BLUE SHIELD
OH0632775Medicaid
OH480014894Medicare PIN
OH000000216707OtherANTHEM BLUE SHIELD
OH0632775Medicaid
OH0584714Medicare PIN
OH0584715Medicare PIN