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General NPI Number Information
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NPI Number | 1144400672
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Entity Type | Organization
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Legal Business Name | JEAN BOTTI LENK M.D., INC
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 99 NORTHLINE CIR STE 200
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City | EUCLID
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State | OH
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Zip | 44119-1481
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Country | US
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Telephone | 216-383-5757
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Fax | 216-383-6565
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Provider Business Mailing Address
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Address Line | 99 NORTHLINE CIR STE 200
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City | EUCLID
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State | OH
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Zip | 44119-1481
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Country | US
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Telephone | 216-383-5757
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Fax | 216-383-6565
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Authorized Official
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Title or Position | MEDICAL BILLER
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Name | MRS. HALLIE B GASIEWSKI
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Credential |
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Telephone | 216-383-5757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35058732
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License Number State | OH
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