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Organization

CLEVELAND BREAST CLINIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
AHMAD H. SHATILA M.D. (PHYSICIAN OWNER)
(440) 234-9338
Entity
Organization

Contact information

Practice address
18660 BAGLEY RD, STE. 305 BLDG. 2, CLEVELAND, OH 44130-3483
(440) 234-9338
(440) 234-1448
Mailing address
18660 BAGLEY RD, STE. 305 BLDG. 2, CLEVELAND, OH 44130-3483
(440) 234-9338
(440) 234-1448

Taxonomy

Speciality
Code
Description
License number
State
2086X0206X
Surgical Oncology Physician
Primary
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000006129197
BLUE CROSS
OH
01
1500454
UMWA
OH
Enumeration date
04/24/2007
Last updated
08/22/2020
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