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Organization
CENTER FOR VASCULAR AND THORACIC MEDICINE AND SURGERY, INC
Active
Organization
CENTER FOR VASCULAR AND THORACIC MEDICINE AND SURGERY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JUDY KLEKOTA CPCS (CREDENTIALING COORDINATOR)
(440) 233-1003
Entity
Organization
Contact information
Practice address
2173 N RIDGE RD E, SUITE A, LORAIN, OH 44055-3400
(440) 277-5077
(440) 277-6696
Mailing address
2173 N RIDGE RD E, SUITE A, LORAIN, OH 44055-3400
(440) 277-5077
(440) 277-6696
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
35053879
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0636306
—
OH
Enumeration date
09/26/2006
Last updated
11/02/2007
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