Healthcare Provider Details

I. General information

NPI: 1407845902
Provider Name (Legal Business Name): JON REISMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2322 E 22ND ST SUITE 200
CLEVELAND OH
44115-3176
US

IV. Provider business mailing address

26908 DETROIT RD SUITE 301
WESTLAKE OH
44145-2398
US

V. Phone/Fax

Practice location:
  • Phone: 216-363-3309
  • Fax: 216-363-2768
Mailing address:
  • Phone: 440-617-1823
  • Fax: 440-617-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35048202
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: