=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134181845
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EUCLID CARDIOLOGY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2006
-----------------------------------------------------
Last Update Date | 01/27/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18901 LAKESHORE BLVD
-----------------------------------------------------
City | EUCLID
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-942-5400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7500 OLD OAK BLVD
-----------------------------------------------------
City | MIDDLEBURG HTS.
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44130-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-777-6300
-----------------------------------------------------
Fax | 440-777-2330
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | ROBERT BOTTI JR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 440-942-4374
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------