Healthcare Provider Details

I. General information

NPI: 1518188879
Provider Name (Legal Business Name): KURTIS CHARLES DORNAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24700 CENTER RIDGE RD STE 370
WESTLAKE OH
44145-5665
US

IV. Provider business mailing address

37855 ELVA LN
NORTH RIDGEVILLE OH
44039-8719
US

V. Phone/Fax

Practice location:
  • Phone: 440-665-1727
  • Fax: 844-749-3974
Mailing address:
  • Phone: 330-473-2201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.088772
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: