MEDICARE: TRACY DILLAHA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		OH

General Provider Information

NPI Number	:	1114884087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY DILLAHA

Provider Business Mailing Address
First Line	:	6960 FRY RD
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-2511
Country	:	US
Telephone Number	:	724-301-8964
Fax Number	:

Provider Business Practice Location Address
First Line	:	12395 MCCRACKEN RD
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-2967
Country	:	US
Telephone Number	:	216-587-6727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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