Healthcare Provider Details

I. General information

NPI: 1427208628
Provider Name (Legal Business Name): WESTLAKE PRIMARY CARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21851 CENTER RIDGE RD 411
ROCKY RIVER OH
44116-3976
US

IV. Provider business mailing address

1502 WEYMOUTH CIR SUITE 309
WESTLAKE OH
44145-6192
US

V. Phone/Fax

Practice location:
  • Phone: 216-437-0047
  • Fax: 206-888-0360
Mailing address:
  • Phone: 440-539-0219
  • Fax: 206-888-0360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateOH

VIII. Authorized Official

Name: DR. PATRICK J FETTERS
Title or Position: DOCTOR
Credential: N.D., MSP
Phone: 216-437-0047