Basic Information
| Provider Information | |||||||||
| NPI: | 1619965449 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PALUTSIS | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 S ARCH AVE | ||||||||
| Address2: | |||||||||
| City: | ALLIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446014202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308210201 | ||||||||
| FaxNumber: | 3308211924 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 S ARCH AVE | ||||||||
| Address2: | |||||||||
| City: | ALLIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446014202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308210201 | ||||||||
| FaxNumber: | 3308211924 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2005 | ||||||||
| LastUpdateDate: | 06/10/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 35063106 | OH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0894493 | 05 | OH | MEDICAID | 341089680 | 01 | OH | GREAT WEST HEALTH | OTHER | 733348 | 01 | OH | BUCKEYE HEALTH PLAN | OTHER | 341089680 | 01 | OH | AULTCARE | OTHER | 341089680023 | 01 | OH | CARESOURCE | OTHER | 4332880 | 01 | OH | AETNA | OTHER | 341089680 | 01 | OH | CIGNA | OTHER | 341089680 | 01 | OH | FIRST HEALTH | OTHER | 341089680 | 01 | OH | PPO NEXT | OTHER | Q012010A | 01 | OH | HOMETOWN HEALTH PLAN | OTHER | 000000126983 | 01 | OH | ANTHEM | OTHER | 341089680 | 01 | OH | DIRECT CARE AMERICA | OTHER | 127480600 | 01 | OH | FEDERAL EMPLOYEES BWC | OTHER |