Provider Demographics
NPI:1386602092
Name:SERTICH, MARIO M (MD)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:M
Last Name:SERTICH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5319 HOAG DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHEFFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1494
Mailing Address - Country:US
Mailing Address - Phone:440-930-6015
Mailing Address - Fax:440-930-6094
Practice Address - Street 1:5319 HOAG DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SHEFFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44035-1494
Practice Address - Country:US
Practice Address - Phone:440-930-6015
Practice Address - Fax:440-930-6094
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2009-11-03
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Provider Licenses
StateLicense IDTaxonomies
OH046671207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0464779Medicaid
OH0498961Medicare PIN
OHA80082Medicare UPIN