Healthcare Provider Details

I. General information

NPI: 1760347710
Provider Name (Legal Business Name): ROBERT CRITTENDON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1496 S GREEN RD
SOUTH EUCLID OH
44121-4038
US

IV. Provider business mailing address

1496 S GREEN RD
CLEVELAND OH
44121-4038
US

V. Phone/Fax

Practice location:
  • Phone: 216-389-7413
  • Fax:
Mailing address:
  • Phone: 216-389-7413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: