Healthcare Provider Details

I. General information

NPI: 1629464029
Provider Name (Legal Business Name): ELIZABETH KIGHTLINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 SOM CENTER RD
WILLOUGHBY HILLS OH
44094-9607
US

IV. Provider business mailing address

2570 SOM CENTER RD
WILLOUGHBY HILLS OH
44094-9607
US

V. Phone/Fax

Practice location:
  • Phone: 216-448-8203
  • Fax:
Mailing address:
  • Phone: 216-448-8203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.136530
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.136530
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: