=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710946785
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAKE COUNTY AND WEST EKG ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2006
-----------------------------------------------------
Last Update Date | 09/18/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7500 AUBURN RD SUITE 200
-----------------------------------------------------
City | PAINESVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44077-9602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-352-2754
-----------------------------------------------------
Fax | 440-352-0330
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30701 LORAIN RD STE A
-----------------------------------------------------
City | NORTH OLMSTED
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44070-6325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-274-5000
-----------------------------------------------------
Fax | 440-716-8608
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. M AHMAD BANNA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 440-358-5555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------