MEDICARE: VERTEX HEALTHCARE LLC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1861356164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERTEX HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	17207 SEDALIA AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-4467
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17207 SEDALIA AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-4467
Country	:	US
Telephone Number	:	763-218-6448
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KYLE JOSEPH KETTLER
Credential	:	MD
Telephone Number	:	763-218-6448

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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Directions to “VERTEX HEALTHCARE LLC ” Practice Location

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