Provider Demographics
NPI:1750337986
Name:BACIK, RONALD (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:BACIK
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:PO BOX 932085
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0001
Mailing Address - Country:US
Mailing Address - Phone:888-328-4492
Mailing Address - Fax:
Practice Address - Street 1:6707 POWERS BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5455
Practice Address - Country:US
Practice Address - Phone:440-886-2509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-035881207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH290008883OtherRAILROAD MEDICARE
OH0337120Medicaid
OHA75860Medicare UPIN
OH0337120Medicaid
OHBA0434204Medicare PIN