Healthcare Provider Details

I. General information

NPI: 1760476709
Provider Name (Legal Business Name): IAN KLETTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29000 CENTER RIDGE RD ST JOHN WEST SHORE HOSPITAL
WESTLAKE OH
44145-5293
US

IV. Provider business mailing address

30680 BAINBRIDGE RD NORTHEAST OHIO GROUP PRACTICE
CLEVELAND OH
44139-2282
US

V. Phone/Fax

Practice location:
  • Phone: 440-835-8000
  • Fax:
Mailing address:
  • Phone: 440-542-5023
  • Fax: 440-542-5029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number35077854K
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.077854
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: