Provider Demographics
NPI:1548339666
Name:PRIZANT, FREDERICK JAY (DPM)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:JAY
Last Name:PRIZANT
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 1:1100 N ABBE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1667
Mailing Address - Country:US
Mailing Address - Phone:440-365-2502
Mailing Address - Fax:
Practice Address - Street 1:1100 N ABBE RD
Practice Address - Street 2:SUITE D
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-1667
Practice Address - Country:US
Practice Address - Phone:440-365-2502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002142213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
160203OtherANTHEM BLUE CROSS
OH0694708Medicaid
160203OtherANTHEM BLUE CROSS
OH0544201Medicare ID - Type Unspecified