MEDICARE: MS. CATHERINE LOUISE LY D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	036.129366	IL
2	207RG0100X	Gastroenterology Physician	34.013947	OH

General Provider Information

NPI Number	:	1750523783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CATHERINE LOUISE LY D.O.

Provider Business Mailing Address
First Line	:	21495 AVALON DR
Second Line	:
City	:	ROCKY RIVER
State	:	OH
Zip	:	44116-1125
Country	:	US
Telephone Number	:	937-974-2036
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-1143
Country	:	US
Telephone Number	:	216-444-2200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2009
Last Update Date	:	07/08/2019

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