Basic Information
| Provider Information | |||||||||
| NPI: | 1659329076 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NETZLEY | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 WABASH AVE | ||||||||
| Address2: | #3500 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443072433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303441400 | ||||||||
| FaxNumber: | 3303440112 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 WABASH AVE | ||||||||
| Address2: | #3500 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443072433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303441400 | ||||||||
| FaxNumber: | 3303440112 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 02/14/2013 | ||||||||
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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 | 2086S0129X | 35-050271 | OH | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 208G00000X | 35-050271 | OH | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 1841239274 | 01 | OH | PARTNERS PHYSICIAN GROUP TYPE 2 NPI # | OTHER | 1265700520 | 01 | OH | SVS - 1761 BEALL AVE., LOCATION TYPE 2 NPI # | OTHER | 1144401464 | 01 | OH | SVS - WABASH AVE LOCATION TYPE 2 NPI # | OTHER | 9338635 | 01 | OH | PARTNERS PHYSICIAN GROUP MEDICARE GROUP # | OTHER | P00744702 | 01 | OH | RR MEDICARE | OTHER | 0628628 | 05 | OH | MEDICAID | 2551671 | 01 | OH | PARTNERS PHYSICIAN GROUP MEDICAID GROUP # | OTHER |