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General NPI Number Information
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NPI Number | 1215155015
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Entity Type | Organization
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Legal Business Name | CLEVELAND BREAST CLINIC
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 18660 BAGLEY RD STE. 305 BLDG. 2
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City | CLEVELAND
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State | OH
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Zip | 44130-3483
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Country | US
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Telephone | 440-234-9338
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Fax | 440-234-1448
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Provider Business Mailing Address
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Address Line | 18660 BAGLEY RD STE. 305 BLDG. 2
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City | CLEVELAND
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State | OH
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Zip | 44130-3483
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Country | US
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Telephone | 440-234-9338
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Fax | 440-234-1448
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | AHMAD H. SHATILA
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Credential | M.D.
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Telephone | 440-234-9338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number |
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License Number State | OH
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