Healthcare Provider Details

I. General information

NPI: 1649842204
Provider Name (Legal Business Name): ONEZA KOTHAWALA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 METROHEALTH DR
CLEVELAND OH
44109-1900
US

IV. Provider business mailing address

12000 EDGEWATER DR APT 702
LAKEWOOD OH
44107-6701
US

V. Phone/Fax

Practice location:
  • Phone: 216-778-4486
  • Fax:
Mailing address:
  • Phone: 240-794-8376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57.250602
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: