Healthcare Provider Details

I. General information

NPI: 1760686398
Provider Name (Legal Business Name): JARED CHRISTOPHER STORCK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28601 CHAGRIN BLVD STE 500
WOODMERE OH
44122-4562
US

IV. Provider business mailing address

28601 CHAGRIN BLVD STE 500
WOODMERE OH
44122-4562
US

V. Phone/Fax

Practice location:
  • Phone: 216-561-0312
  • Fax: 216-561-0113
Mailing address:
  • Phone: 216-561-0312
  • Fax: 216-561-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34-009221
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number34-009221
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: