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General NPI Number Information
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NPI Number | 1255740619
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Entity Type | Organization
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Legal Business Name | KIVA SHTULL MD
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Dates
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Enumeration Date | 08/10/2014
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Last Update Date | 08/10/2014
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Provider Practice Location Address
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Address Line | 4450 SAINT CLAIR AVE
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City | CLEVELAND
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State | OH
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Zip | 44103-1126
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Country | US
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Telephone | 216-431-0927
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Fax |
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Provider Business Mailing Address
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Address Line | 4450 SAINT CLAIR AVE
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City | CLEVELAND
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State | OH
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Zip | 44103-1126
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Country | US
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Telephone | 216-431-0927
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. KIVA SHTULL
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Credential | MD
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Telephone | 216-431-0927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number | 051031
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License Number State | OH
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