Provider Demographics
NPI:1932261963
Name:PAUL F VANEK JR M D INC
Entity Type:Organization
Organization Name:PAUL F VANEK JR M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:VANEK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:440-205-5750
Mailing Address - Street 1:9485 MENTOR AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4597
Mailing Address - Country:US
Mailing Address - Phone:440-205-5750
Mailing Address - Fax:440-205-5752
Practice Address - Street 1:9485 MENTOR AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4597
Practice Address - Country:US
Practice Address - Phone:440-205-5750
Practice Address - Fax:440-205-5752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-0303174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2024026Medicaid
OH2024026Medicaid
OHBV4377238OtherDEA
OHVA0803311Medicare ID - Type Unspecified