Healthcare Provider Details

I. General information

NPI: 1720721475
Provider Name (Legal Business Name): ALEXANDER CLARK MITTMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24800 HIGHPOINT RD
BEACHWOOD OH
44122-6052
US

IV. Provider business mailing address

24800 HIGHPOINT RD
BEACHWOOD OH
44122-6052
US

V. Phone/Fax

Practice location:
  • Phone: 216-342-5496
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.156309
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: