Healthcare Provider Details

I. General information

NPI: 1316818826
Provider Name (Legal Business Name): LUCAS KEINSLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36000 EUCLID AVE
WILLOUGHBY OH
44094-4625
US

IV. Provider business mailing address

2495 SCRANTON RD APT 5
CLEVELAND OH
44113-4348
US

V. Phone/Fax

Practice location:
  • Phone: 440-953-9600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: