Healthcare Provider Details

I. General information

NPI: 1649746124
Provider Name (Legal Business Name): BO ELIZABETH ESPINOSA-SETCHKO MD, MPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13241 RAVENNA RD
CHARDON OH
44024-9012
US

IV. Provider business mailing address

13241 RAVENNA RD
CHARDON OH
44024-9012
US

V. Phone/Fax

Practice location:
  • Phone: 440-285-9166
  • Fax:
Mailing address:
  • Phone: 440-285-9166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.135013
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: