Provider Demographics
NPI:1588928766
Name:ERIC D TRATTNER DPM
Entity type:Organization
Organization Name:ERIC D TRATTNER DPM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:D
Authorized Official - Last Name:TRATTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-405-3301
Mailing Address - Street 1:POST OFFICE BOX 39662
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44139-0662
Mailing Address - Country:US
Mailing Address - Phone:330-405-3301
Mailing Address - Fax:330-405-3315
Practice Address - Street 1:8900 DARROW RD
Practice Address - Street 2:H 110
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-6800
Practice Address - Country:US
Practice Address - Phone:330-405-3301
Practice Address - Fax:330-405-3315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
OH36002488213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0706785Medicaid
OHSP04442OtherMEDICARE PTAN
OHSP04441OtherMEDICARE PTAN
OH0706785Medicaid
OHT80617Medicare UPIN