Healthcare Provider Details

I. General information

NPI: 1275566184
Provider Name (Legal Business Name): BARBARA A BAETZ-GREENWALT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

5910 LANDERBROOK DR SUITE 250
MAYFIELD HTS OH
44124-6508
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-7700
  • Fax: 440-449-1555
Mailing address:
  • Phone: 440-684-5829
  • Fax: 440-449-1555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number35-045792
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: