Healthcare Provider Details

I. General information

NPI: 1376720987
Provider Name (Legal Business Name): NORTHSHORE RESPIRATORY AND SLEEP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 STATE ROUTE 306 #110
WILLOUGHBY OH
44094-9258
US

IV. Provider business mailing address

1450 SOM CENTER RD #25
MAYFIELD HTS OH
44124-2118
US

V. Phone/Fax

Practice location:
  • Phone: 440-954-9388
  • Fax: 440-269-1338
Mailing address:
  • Phone: 440-446-1423
  • Fax: 440-446-1498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY F KOWALSKI
Title or Position: PRESIDENT
Credential:
Phone: 440-954-9388