Provider Demographics
NPI:1487753695
Name:PANUTO, JOHN ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ANTHONY
Last Name:PANUTO
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 1:25761 LORAIN RD
Mailing Address - Street 2:3RD FL
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070
Mailing Address - Country:US
Mailing Address - Phone:440-779-1112
Mailing Address - Fax:440-779-0247
Practice Address - Street 1:25761 LORAIN RD
Practice Address - Street 2:3RD FL
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070
Practice Address - Country:US
Practice Address - Phone:440-779-1112
Practice Address - Fax:440-779-0247
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059393207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH110093482OtherMEDICARE RAILROAD
OH0959655Medicaid
OH110093482OtherMEDICARE RAILROAD
OH0959655Medicaid