Healthcare Provider Details

I. General information

NPI: 1164526158
Provider Name (Legal Business Name): OHIO CHEST PHYSICIANS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15805 PURITAS AVE
CLEVELAND OH
44135-2611
US

IV. Provider business mailing address

PO BOX 932085
CLEVELAND OH
44193-0007
US

V. Phone/Fax

Practice location:
  • Phone: 216-267-5933
  • Fax:
Mailing address:
  • Phone: 888-328-4492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: OLGA GORKAVCHUK
Title or Position: PRACTICE MANAGER
Credential:
Phone: 216-267-5139