MEDICARE: KATHRYN STACKHOUSE

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	208600000X	Surgery Physician	35.145480	OH

General Provider Information

NPI Number	:	1811382443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN STACKHOUSE

Provider Business Mailing Address
First Line	:	2914 W 14TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-5219
Country	:	US
Telephone Number	:	301-788-6293
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-5400
Country	:	US
Telephone Number	:	216-299-0812
Fax Number	:

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

Provider Enumeration Date	:	03/31/2015
Last Update Date	:	06/22/2022

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Directions to “ KATHRYN STACKHOUSE ” Practice Location

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