Healthcare Provider Details

I. General information

NPI: 1801989959
Provider Name (Legal Business Name): ROBERT WHITEHOUSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27155 CHARDON RD STE 205
RICHMOND HTS OH
44143-1166
US

IV. Provider business mailing address

27155 CHARDON RD STE 205
RICHMOND HTS OH
44143-1166
US

V. Phone/Fax

Practice location:
  • Phone: 216-383-0100
  • Fax: 216-383-6481
Mailing address:
  • Phone: 440-944-4070
  • Fax: 440-944-9162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number35-51062
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: