Healthcare Provider Details

I. General information

NPI: 1942202973
Provider Name (Legal Business Name): STEPHANIE M GELETKA MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS STEPHANIE M POLUTNIK

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 METROHEALTH DR
CLEVELAND OH
44109-1900
US

IV. Provider business mailing address

18975 E SHORELAND AVE
ROCKY RIVER OH
44116-2818
US

V. Phone/Fax

Practice location:
  • Phone: 216-778-7800
  • Fax:
Mailing address:
  • Phone: 440-537-9099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number67000091
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: