Provider Demographics
NPI:1154429579
Name:ZNIDARSIC, ADOLPH F (MD)
Entity type:Individual
Prefix:DR
First Name:ADOLPH
Middle Name:F
Last Name:ZNIDARSIC
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 1:23800 CHARDON RD
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1316
Mailing Address - Country:US
Mailing Address - Phone:216-521-8719
Mailing Address - Fax:216-521-1798
Practice Address - Street 1:15621 WATERLOO RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-1657
Practice Address - Country:US
Practice Address - Phone:216-531-2559
Practice Address - Fax:216-531-2559
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.023168207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000128833OtherANTHEM BLUE CROSS
OH9774883Medicaid
OHZN0117701Medicare ID - Type UnspecifiedPALMETTO GBA
OH9774883Medicaid