Healthcare Provider Details

I. General information

NPI: 1912245853
Provider Name (Legal Business Name): CLEVELAND EAST VASCULAR CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 10/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23650 COMMERCE PARK STE B
BEACHWOOD OH
44122-5817
US

IV. Provider business mailing address

9140 CORSEA DEL FONTANA WAY
NAPLES FL
34109-4397
US

V. Phone/Fax

Practice location:
  • Phone: 216-273-8010
  • Fax: 216-378-9005
Mailing address:
  • Phone: 239-597-2010
  • Fax: 239-597-2313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: LISA MCNAMARA
Title or Position: EVP
Credential:
Phone: 239-597-2010