Healthcare Provider Details

I. General information

NPI: 1821521287
Provider Name (Legal Business Name): ANDREW R LAVIK M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # R3-008
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE # R3-008
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-4281
  • Fax:
Mailing address:
  • Phone: 216-444-4281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number35.139104
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: