Healthcare Provider Details

I. General information

NPI: 1578378782
Provider Name (Legal Business Name): CHEST DISEASE ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6707 POWERS BLVD STE 106
PARMA OH
44129-5463
US

IV. Provider business mailing address

6707 POWERS BLVD STE 106
PARMA OH
44129-5463
US

V. Phone/Fax

Practice location:
  • Phone: 440-886-2509
  • Fax: 440-886-2547
Mailing address:
  • Phone: 440-886-2509
  • Fax: 440-886-2547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL V. ILTCHEV
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 216-904-7461