Healthcare Provider Details

I. General information

NPI: 1134576051
Provider Name (Legal Business Name): ALISA TIMASHPOLSKY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # A71
CLEVELAND OH
44195-4319
US

IV. Provider business mailing address

9500 EUCLID AVE # A71
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-0322
  • Fax:
Mailing address:
  • Phone: 216-444-0322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number111468
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberMT222267
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberW8232
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number35.148190
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberMD476752
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: