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General NPI Number Information
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NPI Number | 1437555786
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Entity Type | Individual
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Provider Name | KIVA SHTULL MD
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Gender | Male
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Dates
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Enumeration Date | 11/14/2014
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Last Update Date | 02/11/2016
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Provider Practice Location Address
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Address Line | 7601 FIRST PL STE 7A
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City | OAKWOOD VILLAGE
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State | OH
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Zip | 44146-6702
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Country | US
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Telephone | 440-799-3741
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 051031
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License Number State | OH
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