Provider Demographics
NPI:1982870804
Name:VITULLO, JOHN FRANK II (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:FRANK
Last Name:VITULLO
Suffix:II
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 1:1171 FAIRWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2522
Mailing Address - Country:US
Mailing Address - Phone:614-861-7051
Mailing Address - Fax:614-861-0614
Practice Address - Street 1:1171 FAIRWAY BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2522
Practice Address - Country:US
Practice Address - Phone:614-861-7051
Practice Address - Fax:614-861-0614
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35092579207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3075005Medicaid
OHPENDINGMedicare PIN