MEDICARE: JOHNATHAN DOOLITTLE MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208800000X	Urology Physician	35.139466	OH

General Provider Information

NPI Number	:	1144607508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNATHAN DOOLITTLE MD

Provider Business Mailing Address
First Line	:	538 BROOKHURST DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75218-2128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 E 96TH ST Q BUILDING
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-3548
Country	:	US
Telephone Number	:	216-444-5600
Fax Number	:

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

Provider Enumeration Date	:	05/05/2015
Last Update Date	:	07/20/2020

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Directions to “ JOHNATHAN DOOLITTLE MD” Practice Location

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