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General NPI Number Information
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NPI Number | 1255913117
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Entity Type | Organization
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Legal Business Name | ID CONSULTANTS OF NORTHEAST OHIO, INC
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Dates
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Enumeration Date | 04/21/2021
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Last Update Date | 04/21/2021
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Provider Practice Location Address
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Address Line | 3609 PARK EAST DR STE 207
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City | BEACHWOOD
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State | OH
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Zip | 44122-4309
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Country | US
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Telephone | 216-360-0456
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Fax | 216-360-9449
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Provider Business Mailing Address
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Address Line | 3609 PARK EAST DR STE 207
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City | BEACHWOOD
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State | OH
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Zip | 44122-4309
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Country | US
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Telephone | 216-360-9480
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Fax | 216-360-9449
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Authorized Official
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Title or Position | ADMIN
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Name | VIMALA SHAKAR
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Credential |
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Telephone | 216-702-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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