Individual
DR. JOHN A BASTULLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10515 CARNEGIE AVE, CLEVELAND, OH 44106-3016
(216) 928-0136
(216) 928-0141
Mailing address
10515 CARNEGIE AVE, CLEVELAND, OH 44106-3016
(216) 928-0136
(216) 928-0141
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
35-05-0645
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0703144
—
OH
Enumeration date
09/15/2005
Last updated
10/06/2010
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