Healthcare Provider Details

I. General information

NPI: 1861831463
Provider Name (Legal Business Name): GREAT LAKES HYPERTENSION & KIDNEY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29640 EUCLID AVE
WICKLIFFE OH
44092-1829
US

IV. Provider business mailing address

PO BOX 933335
CLEVELAND OH
44193-0037
US

V. Phone/Fax

Practice location:
  • Phone: 440-463-9596
  • Fax: 440-585-0249
Mailing address:
  • Phone: 440-463-9596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35087500
License Number StateOH

VIII. Authorized Official

Name: IONEL ZAMFIR DONCA
Title or Position: PRESIDENT
Credential: MD
Phone: 440-463-9596