Healthcare Provider Details

I. General information

NPI: 1336138379
Provider Name (Legal Business Name): DAVID W DELZELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36000 EUCLID AVE
WILLOUGHBY OH
44094-4625
US

IV. Provider business mailing address

7757 AUBURN RD UNIT 15
CONCORD TWP OH
44077-9609
US

V. Phone/Fax

Practice location:
  • Phone: 440-350-0832
  • Fax: 440-579-0191
Mailing address:
  • Phone: 309-692-5393
  • Fax: 309-692-2583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.068957
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: