Healthcare Provider Details

I. General information

NPI: 1366079105
Provider Name (Legal Business Name): KATHLEEN MARIE COERDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CLEVELAND CLINIC 9500 EUCLID AVENUE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

CLEVELAND CLINIC 9500 EUCLID AVENUE
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2200
  • Fax:
Mailing address:
  • Phone: 216-444-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35.156970
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: