Healthcare Provider Details

I. General information

NPI: 1821728478
Provider Name (Legal Business Name): GREGORY P KEZELE MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36000 EUCLID AVE
WILLOUGHBY OH
44094-4625
US

IV. Provider business mailing address

601 CLINTON LN
HIGHLAND HTS OH
44143-1962
US

V. Phone/Fax

Practice location:
  • Phone: 440-918-6341
  • Fax: 440-918-6342
Mailing address:
  • Phone: 440-413-0499
  • Fax: 440-446-9095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY P KEZELE
Title or Position: OWNER
Credential: MD
Phone: 440-413-0499