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NPI Code Detail

MEDICARE: DR. NEETI J WYCKOFF D.O.

MEDICARE: DR. NEETI J WYCKOFF 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
1208000000XPediatrics Physician34.009158OH
22084P0800XPsychiatry Physician34.009158OH

General Provider Information

NPI Number : 1811194442
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NEETI J WYCKOFF D.O.
Provider Business Mailing Address
First Line : 11100 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-1716
Country : US
Telephone Number : 216-844-3450
Fax Number : 216-844-4741
Provider Business Practice Location Address
First Line : 25101 CHAGRIN BLVD STE 100
Second Line :
City : BEACHWOOD
State : OH
Zip : 44122-5694
Country : US
Telephone Number : 216-468-5000
Fax Number : 216-456-8128
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2007
Last Update Date : 05/06/2023

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