Healthcare Provider Details

I. General information

NPI: 1043972995
Provider Name (Legal Business Name): SETH FLASK CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26250 EUCLID AVE STE 625
CLEVELAND OH
44132-3693
US

IV. Provider business mailing address

276 ASPEN DR NW
WARREN OH
44483-1183
US

V. Phone/Fax

Practice location:
  • Phone: 216-710-1111
  • Fax:
Mailing address:
  • Phone: 330-883-8012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP.0029714
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: