Healthcare Provider Details

I. General information

NPI: 1598850042
Provider Name (Legal Business Name): JOHN D DORSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 SCIENCE PARK DR
BEACHWOOD OH
44122-7333
US

IV. Provider business mailing address

20775 S. WOODLAND RD.
SHAKER HTS. OH
44122-3011
US

V. Phone/Fax

Practice location:
  • Phone: 216-455-6330
  • Fax:
Mailing address:
  • Phone: 440-536-6759
  • Fax: 216-751-0206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35054025D
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number35054025
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: