Healthcare Provider Details

I. General information

NPI: 1386938538
Provider Name (Legal Business Name): KALEENA CHRISTINE CHILCOTE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-2807
US

IV. Provider business mailing address

9500 EUCLID AVE # CA53
CLEVELAND OH
44195-2807
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-0397
  • Fax:
Mailing address:
  • Phone: 216-445-0397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number28696
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number31.143147
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: