Healthcare Provider Details

I. General information

NPI: 1972901676
Provider Name (Legal Business Name): KAITLIN DIANNA LANIGAN PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12557 RAVENWOOD DR
CHARDON OH
44024-9009
US

IV. Provider business mailing address

13870 INDIAN CREEK DR
MIDDLEBURG HEIGHTS OH
44130-6815
US

V. Phone/Fax

Practice location:
  • Phone: 440-285-3568
  • Fax:
Mailing address:
  • Phone: 440-342-4075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC 1200447
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: