Provider Demographics
NPI:1548698368
Name:DR BARBARA LYNN PETKOVIC DPM LLC
Entity type:Organization
Organization Name:DR BARBARA LYNN PETKOVIC DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PETKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-885-2130
Mailing Address - Street 1:PO BOX 33501
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-0501
Mailing Address - Country:US
Mailing Address - Phone:440-885-2130
Mailing Address - Fax:440-848-8406
Practice Address - Street 1:10631 SHERWOOD TRL
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-1979
Practice Address - Country:US
Practice Address - Phone:440-885-2130
Practice Address - Fax:440-848-8406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty