Healthcare Provider Details

I. General information

NPI: 1013551324
Provider Name (Legal Business Name): ELIZABETH KALLAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38882 MENTOR AVE
WILLOUGHBY OH
44094-7875
US

IV. Provider business mailing address

38882 MENTOR AVE
WILLOUGHBY OH
44094-7875
US

V. Phone/Fax

Practice location:
  • Phone: 440-578-8200
  • Fax:
Mailing address:
  • Phone: 440-578-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: