# CENTER FOR VASCULAR AND THORACIC MEDICINE AND SURGERY, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467553206
- **Authorized official:** MRS. JUDY KLEKOTA CPCS (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (440) 233-1003

## Contact information

- **Practice address:** 2173 N RIDGE RD E, SUITE A, LORAIN, OH 44055-3400
- **Practice address phone:** (440) 277-5077
- **Practice address fax:** (440) 277-6696
- **Mailing address:** 2173 N RIDGE RD E, SUITE A, LORAIN, OH 44055-3400
- **Mailing address phone:** (440) 277-5077
- **Mailing address fax:** (440) 277-6696

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 35053879 | OH | Yes |

## Other

- **Enumeration date:** 09/26/2006
- **Last updated:** 11/02/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0636306 | — | OH |