Organization
EASTSIDE ENT SPECIALISTS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. E. LUKE BOLD M.D. (VICE PRESIDENT)
(440) 352-1474
Entity
Organization
Contact information
Practice address
7580 AUBURN ROAD, #103, PAINESVILLE, OH 44077
(440) 352-1474
(440) 352-2662
Mailing address
7580 AUBURN ROAD, #103, PAINESVILLE, OH 44077
(440) 352-1474
(440) 352-2662
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0666364
—
OH
Enumeration date
01/25/2006
Last updated
02/16/2010
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