Provider Demographics
NPI:1528093473
Name:SIDOTI, SALVATORE PATRICK (DPM)
Entity type:Individual
Prefix:
First Name:SALVATORE
Middle Name:PATRICK
Last Name:SIDOTI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6681 RIDGE ROAD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5705
Mailing Address - Country:US
Mailing Address - Phone:440-884-4114
Mailing Address - Fax:440-884-7661
Practice Address - Street 1:6681 RIDGE RD
Practice Address - Street 2:SUITE 405
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5705
Practice Address - Country:US
Practice Address - Phone:440-884-4114
Practice Address - Fax:440-884-7661
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.002376213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000137465OtherANTHEM
OH0652815Medicaid
OH104030OtherKAISER HMO
OH1367002OtherUNITED MINE WORKERS
OH260015717Medicare PIN
OH000000137465OtherANTHEM
OH0652815Medicaid
OH1367002OtherUNITED MINE WORKERS