Healthcare Provider Details

I. General information

NPI: 1255958500
Provider Name (Legal Business Name): CLEVELAND KIDNEY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 ELEVEN RIV
ROCKY RIVER OH
44116-1777
US

IV. Provider business mailing address

5 ELEVEN RIV
ROCKY RIVER OH
44116-1777
US

V. Phone/Fax

Practice location:
  • Phone: 216-401-8323
  • Fax:
Mailing address:
  • Phone: 216-401-8323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WASSIM ANTOINE EL-HITTI
Title or Position: CEO/PHYSICIAN
Credential: MD
Phone: 216-401-8323