Healthcare Provider Details

I. General information

NPI: 1366653610
Provider Name (Legal Business Name): LUTUL DASHAUN FARROW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVENUE A41
CLEVELAND OH
44195
US

IV. Provider business mailing address

3915 ORCHARD RD
CLEVELAND HEIGHTS OH
44121-2411
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-9507
  • Fax: 216-445-7362
Mailing address:
  • Phone: 216-382-9853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35086437
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number35086437
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: