# OUTREACH PROFESSIONAL SERVICES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Cuyahoga Physician Network
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538334545
- **Authorized official:** MISTY A BLAYLOCK (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (440) 892-6406

## Contact information

- **Practice address:** 15644 MADISON AVE, SUITE 202, LAKEWOOD, OH 44107-5622
- **Practice address phone:** (216) 251-3384
- **Mailing address:** 26908 DETROIT RD, SUITE 301, WESTLAKE, OH 44145-2398
- **Mailing address phone:** (440) 617-1823
- **Mailing address fax:** (440) 617-0884

## Taxonomy

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

## Other

- **Enumeration date:** 04/30/2008
- **Last updated:** 01/12/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0251856 | — | OH |