MEDICARE: KEISHA DESGOUTTES

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	247200000X	Other Technician		OH

General Provider Information

NPI Number	:	1164239059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEISHA DESGOUTTES

Provider Business Mailing Address
First Line	:	3579 ATHERSTONE RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44121-1355
Country	:	US
Telephone Number	:	754-201-7180
Fax Number	:

Provider Business Practice Location Address
First Line	:	3579 ATHERSTONE RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44121-1355
Country	:	US
Telephone Number	:	754-201-7180
Fax Number	:

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

Provider Enumeration Date	:	12/13/2024
Last Update Date	:	12/13/2024

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Directions to “ KEISHA DESGOUTTES ” Practice Location

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