Healthcare Provider Details

I. General information

NPI: 1710069562
Provider Name (Legal Business Name): JOHN OTOOLE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 KOLBE RD #202
LORAIN OH
44053
US

IV. Provider business mailing address

1751 FARRS GARDEN PATH
WESTLAKE OH
44145
US

V. Phone/Fax

Practice location:
  • Phone: 216-443-0430
  • Fax: 216-443-0435
Mailing address:
  • Phone: 440-892-3412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35066945
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35066945
License Number StateOH

VIII. Authorized Official

Name: JOHN MICHAEL OTOOLE
Title or Position: PRESIDENT
Credential: MD
Phone: 440-892-3412