Healthcare Provider Details

I. General information

NPI: 1053509869
Provider Name (Legal Business Name): ENRIQUE COTES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 10/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15644 MADISON AVE SUITE 218
LAKEWOOD OH
44107-5622
US

IV. Provider business mailing address

20525 CENTER RIDGE RD SUITE 220
ROCKY RIVER OH
44116-3437
US

V. Phone/Fax

Practice location:
  • Phone: 216-227-9839
  • Fax: 216-227-9867
Mailing address:
  • Phone: 440-895-5056
  • Fax: 440-333-2935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number35-061827
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: