Healthcare Provider Details

I. General information

NPI: 1578763330
Provider Name (Legal Business Name): TRACY LYNN GULLING-LEFTWICH D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY LYNN GULLING DO

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE M2-ANNEX
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE # CA53
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-0933
  • Fax: 216-445-8530
Mailing address:
  • Phone: 216-445-0132
  • Fax: 216-636-3179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number048593
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.011315
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number34.011315
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number34.011315
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: