Healthcare Provider Details

I. General information

NPI: 1114677903
Provider Name (Legal Business Name): SPENCER WILLETTE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

16621 TIMBERLINE DR
STRONGSVILLE OH
44136-7344
US

V. Phone/Fax

Practice location:
  • Phone: 855-415-4234
  • Fax:
Mailing address:
  • Phone: 614-288-8806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number34.018365
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: